MedicaidCoverageMedium impact
PT 46-26: Calculating Continuous Stays under HealthChoice Long Term Care Coverage
Maryland Medicaid·MD · Geriatrics·Managed Care
Effective date
Dec 19, 2025
We identified it
Jun 18, 2026
Summary
Maryland clarifies how to calculate the 90-day continuous stay limit for HealthChoice Medicaid long-term care coverage when patients have hospital interruptions. Hospital days count toward the 90-day limit if the patient returns to the long-term care facility before day 91, but the count restarts if they return after day 90 (with exceptions for facilities that request level of care determinations after day 75).
Action Required
Immediately: Billing teams at long-term care facilities, skilled nursing facilities, and nursing homes in Maryland must update their patient tracking systems to properly calculate continuous stay days for HealthChoice Medicaid enrollees. When patients are hospitalized during LTCF stays, count hospital days toward the 90-day limit if they return before day 91. Reset the 90-day count if patients return after day 90, unless a level of care determination was requested on/after day 75. Continue coordinating with the HealthChoice MCO for payment authorization until official disenrollment occurs.