Your Caregiver ID Number was provided in your caregiver registration approval email. If you registered, but do not know your Caregiver ID Number, please contact MMCC. If you have not registered yet, please register. Please note that the caregiver must be a legal guardian of the minor patient.

You must provide the last four digits of the patient’s SSN to register a patient.

Please download the Minor Patient Form, complete the form, get it notarized, then scan or take a clear picture of the completed form.

You must upload a copy of the minor patient’s birth certificate, adoption papers, or a court order awarding guardianship.

The caregiver must upload a copy of his/her valid US government-issued photo ID, such as a driver’s license, passport or military ID.

This must be a clear, color photo of the patient’s unobscured face taken within the last six months to reflect the patient’s current appearance with a plain white or off-white background. The patient must be directly facing the camera and should have a neutral facial expression or natural smile with both eyes open. Generally, the photo should look like a driver’s license or passport photo. The file must be an image (.jpg, .png or .gif) no larger than 3 MB in size and may not be digitally enhanced or altered in a way that changes the patient’s appearance. Please refer to the Registration Instructions for more information concerning the photo requirements.

The Commission will use the email address you provide on your registration application to communicate with you regarding your registration. You must provide an email address to which you have access in order to receive those communications.

Your Caregiver ID Number was provided in your caregiver registration approval email. If you registered, but do not know your Caregiver ID Number, please contact MMCC. If you have not registered yet, please register. Please note that the caregiver must be a legal guardian of the minor patient.

You must provide the last four digits of the patient’s SSN to register a patient.

Please download the Minor Patient Form, complete the form, get it notarized, then scan or take a clear picture of the completed form.

You must upload a copy of the minor patient’s birth certificate, adoption papers, or a court order awarding guardianship.

The caregiver must upload a copy of his/her valid US government-issued photo ID, such as a driver's license, passport or military id.

A hospice patient must provide either a clear, color photo of the patient’s face taken within the last six months to reflect the patient’s current appearance or a letter from the attending hospice provider (Attending of Hospice Record or AOHR) on hospice letterhead stating that the patient is under his or her care.
If using a photo, it must be a clear, color photo of the patient’s unobscured face taken within the last six months to reflect the patient’s current appearance with a plain white or off-white background. The patient must be directly facing the camera and should have a neutral facial expression or natural smile with both eyes open. Generally, the photo should look like a driver’s license or passport photo. The file must be an image (.jpg, .png or .gif) no larger than 3 MB in size and may not be digitally enhanced or altered in a way that changes the patient’s appearance.
If submitting a letter, it must be from the Attending of Hospice Record provider on hospice letterhead stating that the patient is a hospice patient under his or her care. The file can be uploaded in .jpg or .pdf format.
Please refer to the Registration Instructions for more information concerning the photo and AOHR letter requirements.

The Commission will use the email address you provide on your registration application to communicate with you regarding your registration. You must provide an email address to which you have access in order to receive those communications.

The patient must upload a copy of his/her valid US government-issued photo ID, such as a driver's license, passport or military id. If the government ID you are providing is not a Maryland driver’s license or MVA ID card, OR does not identify your current residential address, you must also provide two (2) source documents as proof of your current Maryland address. If registering a minor patient who does not have a government photo ID, upload the caregiver’s ID. Please refer to the MMCC website for more information.

You must provide the last four digits of the patient’s SSN to register a patient.

Photo:

A hospice patient must provide either 1. A clear, color photo of the patient’s face taken within the last six months to reflect the patient’s current appearance or 2. A letter from the attending hospice provider (Attending of Hospice Record or AOHR) on hospice letterhead stating that the patient is under his or her care.

REQUIRED: AOHR Letter

A letter must submitted from the Attending of Hospice Record provider on hospice letterhead stating that the patient is a hospice patient under his or her care. The file can be uploaded in .jpg or .pdf format.

The Commission will use the email address you provide on your registration application to communicate with you regarding your registration. You must provide an email address to which you have access in order to receive those communications.

Your Caregiver ID Number was provided in your caregiver registration approval email. If you registered, but do not know your Caregiver ID Number, please contact MMCC. If you have not registered yet, please register. Please note that the caregiver must be a legal guardian of the minor patient.

You must provide the last four digits of the patient’s SSN to register a patient.

Please download the Minor Patient Form, complete the form, get it notarized, then scan or take a clear picture of the completed form.

You must upload a copy of the minor patient’s birth certificate, adoption papers, or a court order awarding guardianship.

The caregiver must upload a copy of his/her valid US government-issued photo ID, such as a driver’s license, passport or military ID.

This must be a clear, color photo of the patient’s unobscured face taken within the last six months to reflect the patient’s current appearance with a plain white or off-white background. The patient must be directly facing the camera and should have a neutral facial expression or natural smile with both eyes open. Generally, the photo should look like a driver’s license or passport photo. The file must be an image (.jpg, .png or .gif) no larger than 3 MB in size and may not be digitally enhanced or altered in a way that changes the patient’s appearance. Please refer to the Registration Instructions for more information concerning the photo requirements.

The Commission will use the email address you provide on your registration application to communicate with you regarding your registration. You must provide an email address to which you have access in order to receive those communications.

This is the ID number found on your State of Maryland Medicaid Program (Red) ID card.If you have lost this card and need a replacement, please contact Maryland Medicaid Beneficiary Services at 1-800-492-5231, Maryland Health Connection at 1-855-642-8572 (TTY: 1-855-642-8573).

Upload an electronic copy of your State of Maryland Medicaid Program (Red) ID card.If you have lost this card and need a replacement, please contact Maryland Medicaid Beneficiary Services at 1-800-492-5231, or the Maryland Health Connection at 1-855-642-8572 (TTY: 1-855-642-8573).

Proof of Current Maryland Medicaid Enrollment
1) A Certificate of Creditable Coverage, which can be obtained by contacting Maryland Medicaid Beneficiary Services at 1-800-492-5231 , OR 2) An Eligibility Determination Letter from the Maryland Health Connection, which can be obtained through your Maryland Health Connection account, or by contacting 1-855-642-8572.

Your Caregiver ID Number was provided in your caregiver registration approval email. If you registered, but do not know your Caregiver ID Number, please contact MMCC. If you have not registered yet, please register. Please note that the caregiver must be a legal guardian of the minor patient.

You must provide the last four digits of the patient’s SSN to register a patient.

Please download the Minor Patient Form, complete the form, get it notarized, then scan or take a clear picture of the completed form.

You must upload a copy of the minor patient’s birth certificate, adoption papers, or a court order awarding guardianship.

The caregiver must upload a copy of his/her valid US government-issued photo ID, such as a driver's license, passport or military id.

A hospice patient must provide either a clear, color photo of the patient’s face taken within the last six months to reflect the patient’s current appearance or a letter from the attending hospice provider (Attending of Hospice Record or AOHR) on hospice letterhead stating that the patient is under his or her care.
If using a photo, it must be a clear, color photo of the patient’s unobscured face taken within the last six months to reflect the patient’s current appearance with a plain white or off-white background. The patient must be directly facing the camera and should have a neutral facial expression or natural smile with both eyes open. Generally, the photo should look like a driver’s license or passport photo. The file must be an image (.jpg, .png or .gif) no larger than 3 MB in size and may not be digitally enhanced or altered in a way that changes the patient’s appearance.
If submitting a letter, it must be from the Attending of Hospice Record provider on hospice letterhead stating that the patient is a hospice patient under his or her care. The file can be uploaded in .jpg or .pdf format.
Please refer to the Registration Instructions for more information concerning the photo and AOHR letter requirements.

The Commission will use the email address you provide on your registration application to communicate with you regarding your registration. You must provide an email address to which you have access in order to receive those communications.

This is the ID number found on your State of Maryland Medicaid Program (Red) ID card.If you have lost this card and need a replacement, please contact Maryland Medicaid Beneficiary Services at 1-800-492-5231, Maryland Health Connection at 1-855-642-8572 (TTY: 1-855-642-8573).

Upload an electronic copy of your State of Maryland Medicaid Program (Red) ID card.If you have lost this card and need a replacement, please contact Maryland Medicaid Beneficiary Services at 1-800-492-5231, or the Maryland Health Connection at 1-855-642-8572 (TTY: 1-855-642-8573).

Proof of Current Maryland Medicaid Enrollment
1) A Certificate of Creditable Coverage, which can be obtained by contacting Maryland Medicaid Beneficiary Services at 1-800-492-5231, OR
2) An Eligibility Determination Letter from the Maryland Health Connection, which can be obtained through your Maryland Health Connection account, or by contacting 1-855-642-8572.

The patient must upload a copy of his/her valid US government-issued photo ID, such as a driver's license, passport or military id. If the government ID you are providing is not a Maryland driver’s license or MVA ID card, OR does not identify your current residential address, you must also provide two (2) source documents as proof of your current Maryland address. If registering a minor patient who does not have a government photo ID, upload the caregiver’s ID. Please refer to the MMCC website for more information.

You must provide the last four digits of the patient’s SSN to register a patient.

Photo:

A hospice patient must provide either 1. A clear, color photo of the patient’s face taken within the last six months to reflect the patient’s current appearance or 2. A letter from the attending hospice provider (Attending of Hospice Record or AOHR) on hospice letterhead stating that the patient is under his or her care.

REQUIRED: AOHR Letter

A letter must submitted from the Attending of Hospice Record provider on hospice letterhead stating that the patient is a hospice patient under his or her care. The file can be uploaded in .jpg or .pdf format.

The Commission will use the email address you provide on your registration application to communicate with you regarding your registration. You must provide an email address to which you have access in order to receive those communications.

This is the ID number found on your State of Maryland Medicaid Program (Red) ID card.If you have lost this card and need a replacement, please contact Maryland Medicaid Beneficiary Services at 1-800-492-5231 , Maryland Health Connection at 1-855-642-8572 (TTY: 1-855-642-8573).

Upload an electronic copy of your State of Maryland Medicaid Program (Red) ID card.If you have lost this card and need a replacement, please contact Maryland Medicaid Beneficiary Services at 1-800-492-5231, or the Maryland Health Connection at 1-855-642-8572 (TTY: 1-855-642-8573).

Proof of Current Maryland Medicaid Enrollment
1) A Certificate of Creditable Coverage, which can be obtained by contacting Maryland Medicaid Beneficiary Services at 1-800-492-5231, OR
2) An Eligibility Determination Letter from the Maryland Health Connection, which can be obtained through your Maryland Health Connection account, or by contacting 1-855-642-8572.

Your Caregiver ID Number was provided in your caregiver registration approval email. If you registered, but do not know your Caregiver ID Number, please contact MMCC. If you have not registered yet, please register. Please note that the caregiver must be a legal guardian of the minor patient.

You must provide the last four digits of the patient’s SSN to register a patient.

Please download the Minor Patient Form, complete the form, get it notarized, then scan or take a clear picture of the completed form.

You must upload a copy of the minor patient’s birth certificate, adoption papers, or a court order awarding guardianship.

The caregiver must upload a copy of his/her valid US government-issued photo ID, such as a driver’s license, passport or military ID.

This must be a clear, color photo of the patient’s unobscured face taken within the last six months to reflect the patient’s current appearance with a plain white or off-white background.The patient must be directly facing the camera and should have a neutral facial expression or natural smile with both eyes open. Generally, the photo should look like a driver’s license or passport photo. The file must be an image (.jpg, .png or .gif) no larger than 3 MB in size and may not be digitally enhanced or altered in a way that changes the patient’s appearance. Please refer to the Registration Instructions for more information concerning the photo requirements.

The Commission will use the email address you provide on your registration application to communicate with you regarding your registration. You must provide an email address to which you have access in order to receive those communications.

You must provide Copy of your Maryland Veterans Affairs health insurance card.

Your Caregiver ID Number was provided in your caregiver registration approval email. If you registered, but do not know your Caregiver ID Number, please contact MMCC. If you have not registered yet, please register. Please note that the caregiver must be a legal guardian of the minor patient.

You must provide the last four digits of the patient’s SSN to register a patient.

Please download the Minor Patient Form, complete the form, get it notarized, then scan or take a clear picture of the completed form.

You must upload a copy of the minor patient’s birth certificate, adoption papers, or a court order awarding guardianship.

The caregiver must upload a copy of his/her valid US government-issued photo ID, such as a driver's license, passport or military id.

A hospice patient must provide either a clear, color photo of the patient’s face taken within the last six months to reflect the patient’s current appearance or a letter from the attending hospice provider (Attending of Hospice Record or AOHR) on hospice letterhead stating that the patient is under his or her care.
If using a photo, it must be a clear, color photo of the patient’s unobscured face taken within the last six months to reflect the patient’s current appearance with a plain white or off-white background. The patient must be directly facing the camera and should have a neutral facial expression or natural smile with both eyes open. Generally, the photo should look like a driver’s license or passport photo. The file must be an image (.jpg, .png or .gif) no larger than 3 MB in size and may not be digitally enhanced or altered in a way that changes the patient’s appearance.
If submitting a letter, it must be from the Attending of Hospice Record provider on hospice letterhead stating that the patient is a hospice patient under his or her care. The file can be uploaded in .jpg or .pdf format.
Please refer to the Registration Instructions for more information concerning the photo and AOHR letter requirements.

The Commission will use the email address you provide on your registration application to communicate with you regarding your registration. You must provide an email address to which you have access in order to receive those communications.

You must provide Copy of your Maryland Veterans Affairs health insurance card

The patient must upload a copy of his/her valid US government-issued photo ID, such as a driver's license, passport or military id. If the government ID you are providing is not a Maryland driver’s license or MVA ID card, OR does not identify your current residential address, you must also provide two (2) source documents as proof of your current Maryland address. If registering a minor patient who does not have a government photo ID, upload the caregiver’s ID. Please refer to the MMCC website for more information.

You must provide the last four digits of the patient’s SSN to register a patient.

Photo:

A hospice patient must provide either 1. A clear, color photo of the patient’s face taken within the last six months to reflect the patient’s current appearance or 2. A letter from the attending hospice provider (Attending of Hospice Record or AOHR) on hospice letterhead stating that the patient is under his or her care.

REQUIRED: AOHR Letter

A letter must submitted from the Attending of Hospice Record provider on hospice letterhead stating that the patient is a hospice patient under his or her care. The file can be uploaded in .jpg or .pdf format.

The Commission will use the email address you provide on your registration application to communicate with you regarding your registration. You must provide an email address to which you have access in order to receive those communications.

You must provide Copy of your Maryland Veterans Affairs health insurance card