Frequently Asked Questions

We take the mystery out of the process by providing the information below to educate our Members on the most common medical issues.

What is Medicaid?
Medicaid is a program created by the Federal Government, but administered by the State of Maryland to provide payment for medical services for low-income individuals. A person may qualify for Medicaid by meeting federal income and asset standards and/or meet other eligibility requirements.

How can I get Medicaid?
In order to determine if you are eligible for the Medicaid Program, please refer to the federal income guidelines available here. For more information on how to apply for Medicaid, please see our Become a Member page.

What is the Maryland Children’s Health Program (MCHP)?
The Maryland Children’s Health Program (MCHP) is a program that was started in July 1998. The program provides full health benefits for children up to age 19, and pregnant women of any age who meet the income guidelines. To find out if you are eligible or to apply for MCHP, please see our Become a Member page.

How do I enroll with Jai Medical Systems Managed Care Organization, Inc.?
If you are already eligible for Maryland Medicaid, enrolling with Jai Medical Systems is easy. Please contact the State of Maryland Enrollment Broker today at 1-855-642-8572.

How long does it take to receive a new membership ID card?
Member ID cards will be received within 7–10 business days of the initial request. To request a new ID card, click here or you may request a new ID card by contacting our Customer Service Department at 1-888-JAI-1999.

Is my newborn automatically enrolled?
Your newborn will be automatically enrolled in Jai Medical Systems if you are enrolled on the day your baby is born. Please make sure your hospital knows that you are a Jai Medical Systems member, so that your baby can be enrolled quickly.

How do I schedule an appointment to see my Primary Care Provider (PCP)?
We understand the importance of convenience and flexibility. To schedule an appointment with your Primary Care Provider, please contact your PCP directly by calling the office phone number present on the front of your Member ID card.

How do I update my address and/or phone number?
Members can update their home address and phone number online through the Member Portal or by calling our Customer Service Department at 1-888-JAI-1999.

How do I change my Primary Care Provider (PCP)?
Every member has the right to change their Primary Care Provider at any time. Simply contact our Customer Service Department at 1-888-JAI-1999 or click here to change your PCP online.  In most cases, this change will be effective the same day.

How do I obtain a listing of Primary Care Providers and Specialists who participate with Jai Medical Systems?
For the most up-to-date information concerning the providers participating with our network, please visit our Find a Provider searchable directory. If you have a specific question about a provider or cannot locate a provider, please contact our Customer Service Department at 1-888-JAI-1999.

How do I obtain a referral for specialty care?
If you are in need of specialty care, your Primary Care Provider may refer you to a specialist. Please note, some procedures and services may require Prior Authorization. For a list of services and procedures that require prior authorization, please review our Prior Authorization Guidelines.

How do I get devices/equipment for my Asthma or COPD?

• Nebulizers (a device that turns liquid medicine into a mist) – Talk to your PCP about getting a referral to a participating Durable Medical Equipment (DME) provider.
• Peak Flow Meters (a device that measures how much air you can push out of your lungs) – Talk to your PCP about getting a referral to a participating Durable Medical Equipment (DME) provider.
• Spacers/Valved Holding Chambers (a device you attach to your inhaler to help you slowly breath the medication into your lungs) – You can get certain Optichamber brand devices from our drug list with a prescription from your PCP. For other brands, talk to your PCP about getting a referral to a participating Durable Medical Equipment (DME) provider.

Please contact our Customer Service Department at 1-888-524-1999 with any questions.

What should I do if I receive a bill?
Please contact our Customer Service Department at 1-888-524-1999. Do not pay for a service that is not your responsibility as you may not be reimbursed. Members have no financial liability for covered benefits under the HealthChoice program. With few exceptions, Medicaid and HealthChoice providers are not allowed to bill members. Small pharmacy co-pays and copays for optional services such as adult dental and eyeglasses for adults are examples of services you could be billed for.

Is there a co-pay for pharmacy prescriptions?
Beginning on May 1, 2024, Jai Medical Systems will be required to charge the following pharmacy prescription co-payments:

● $1.00 co-payment on new and refilled preferred brand name and generic drugs, and HIV/AIDS drugs.
● $3.00 co-payment on new and refilled non-preferred brand name drugs.

Please note, in accordance with applicable federal and state statutory requirements, individuals under the age of 21, pregnant women, and Native Americans are not required to pay co-payments.  If you fall into one of these categories and are being charged a prescription co-pay, please contact us at 1-888-524-1999.  Co-payments also do not apply to family planning drugs.

How do I file a formal grievance or appeal?
If you have would like to submit a grievance or an appeal for a requested a service that was denied by Jai Medical Systems, please fill out the Request for Grievance/Appeal Form.  Once completed, please send the form to Jai Medical Systems, 5010 York Road, Baltimore, MD 21212.

Do I need a referral for dental care?
Referrals are not needed for dental care.  The Maryland Healthy Smiles Dental Program (MHSDP) provides dental care to eligible Medicaid members.  Medicaid covers a wide range of dental services. A benefits management company, Skygen, runs the program for Medicaid.  There are no premiums, deductibles, or copays for covered services.  There is no maximum benefit amount each year, except for Adult Dental Pilot members. MHSDP members should never pay for covered services out of pocket.​

Do I need a referral for vision care?  
Referrals are not needed for vision care. For information about your vision benefits, please see the Jai Medical Systems Member handbook. To find an eye doctor near you, please call Versant Health at 1-800-879-6901.

Who should I call if I need help with Mental Health services?
For mental health services, please contact Optum at 1-800-888-1965.

Do I need to contact Jai Medical Systems prior to going to the emergency room (ER)?
If you have a real medical emergency*, please call 911 and/or go to the nearest emergency room (ER). If you’re not sure if you should go to the ER, call your PCP for advice.

*A medical emergency is defined as a health problem that happens suddenly and has symptoms of enough severity, including extreme pain, that the absence of immediate medical attention could reasonably be expected to result in placing your health (or in respect to pregnant women, the health of the woman and her unborn child) in serious jeopardy or serious loss of function to some part of your body.

How do I schedule transportation for my next appointment?
Free transportation is available to and from your appointments with your Primary Care Provider. To schedule an appointment for transportation, call Customer Service at 1-888-JAI-1999.

What are Advanced Directives?
An advanced directive, also known as a living will or personal directive, is a legal document that allows you to plan for future health care decisions. To learn more about advanced directives and how to create an electronic Advanced Directive, please click here.  If you have any legal questions about your personal situation, you should consult your own lawyer. If you decide to make an advance directive, be sure to talk about it with those close to you. The conversation is just as important as the document.

What if I no longer qualify for Medicaid benefits?
If you no longer qualify for Medicaid benefits, you are able to apply and obtain private health insurance through various Qualified Health Plans via the Maryland Health Connection website. The cost of the private health insurance will depend on your family’s income and household size. For assistance with applying for private health insurance, please visit the Maryland Health Connection website. For assistance with managing the cost of private health insurance, please consider resources such as a Health Savings Account. More information regarding Health Savings Accounts can be found at http://www.hsacenter.com/what-is-hsa.html.