Background
The Centers for Medicare and Medicaid Services (CMS) has authorized the Maryland Department of Health's (the Department) existing §1115 waiver through December 31, 2026. HealthChoice, first implemented in 1997 under the authority of §1115 of the Social Security Act, is Maryland’s statewide mandatory managed care program for Medicaid enrollees. Under HealthChoice, eligible families and individuals are required to enroll in a managed care organization (MCO) that has been approved by the Department. Each MCO is responsible for ensuring that HealthChoice enrollees have access to a network of medical providers that can meet their health needs. The Department's current §1115 Waiver Special Terms and Conditions can be found here.
§1115 Waiver Amendment 2023
Public Notice of 2023 Waiver Amendment
Notice in Maryland Register - Posted August 25, 2023
Notice in Maryland Register - Posted September 8, 2023
The Maryland Department of Health (MDH) is proposing an amendment to its §1115 demonstration waiver known as HealthChoice, which the Centers for Medicare and Medicaid Services (CMS) has authorized through December 31, 2026. HealthChoice, first implemented in 1997 under the authority of §1115 of the Social Security Act, is Maryland’s statewide mandatory managed care program for Medicaid enrollees. Under HealthChoice, eligible families and individuals are required to enroll in a managed care organization (MCO) that has been approved by MDH. Each MCO is responsible for ensuring that HealthChoice enrollees have access to a network of medical providers that can meet their health needs.
MDH intends to seek approval to implement Express Lane Eligibility, authorized by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), to renew Medicaid and/or Children’s Health Insurance Program (CHIP) coverage for members of an eligible child’s Supplemental Nutrition Assistance Program (SNAP) household up to age 65 that are already enrolled in Medicaid and/or CHIP. Additionally, MDH is requesting 1115 waiver authority to adopt on a permanent basis the temporary 1135 waiver granted during the national public health emergency, regarding the Four Walls Requirement for clinics authorized under C.F.R. § 440.90.
The State’s 30-day public comment period will open on September 1, 2023. Electronic copies of the draft waiver amendment application will be available on that date and may be downloaded from https://mmcp.health.maryland.gov/Pages/1115-HealthChoice-Waiver-Renewal.aspx. Hard copies of the application may be obtained by calling (410) 767-5208.
Interested parties may send written comments concerning the waiver amendment to Laura Goodman, Office of Innovation, Research and Development Office of Health Care Financing, Maryland Department of Health, 201 West Preston Street, Room 224, Baltimore, Maryland 21201 or via email to mdh.healthchoicerenewal@maryland.gov. MDH will accept comments from September 1, 2023 until October 2, 2023.
The following public hearings will discuss the content of the waiver amendment and solicit feedback and input from public stakeholders. Please note that if you desire to make a public comment, you will need to register via the links below. After registering, you will receive a confirmation email containing audio and visual information about joining the webinar.
Tuesday, September 12, 2023; 3:00PM–4:00PM
Maryland Department of Health
GoToWebinar Virtual Platform
Agenda and Slides
Thursday, September 28, 2023; 1:00PM–3:00PM
Maryland Department of Health
September MMAC Meeting
GoToWebinar Virtual Platform
Agenda and Slides
§1115 Waiver Amendment 2022 - Updated June 30, 2022
The Department has submitted an amendment to the §1115 HealthChoice Demonstration Waiver to the Centers for Medicare and Medicaid Services (CMS).
The Department provided public notice of its intent to submit to CMS, and received public comments on the planned amendments between May 25, 2022 and June 25, 2022.
Full Waiver Amendment with Appendices
Public Notice of 2022 Waiver Amendment
Hard copies of the application may be obtained by calling (410) 767-5208.
Interested parties may send written comments concerning the waiver amendment via email to mdh.healthchoicerenewal@maryland.gov or via hard copy to:
Tricia Roddy
Deputy Medicaid Director, Office of Healthcare Financing
Maryland Department of Health
201 West Preston Street, Room 224
Baltimore, Maryland 21201
§1115 Waiver Renewal Application (2021) - Updated June 22, 2022
Effective January 1, 2022, the Centers for Medicare & Medicaid Services (CMS) approved and renewed Maryland's §1115 demonstration waiver, known as HealthChoice, for a period of five years.
HealthChoice, first implemented in 1997 under the authority of Section 1115 of the Social Security Act, is Maryland’s statewide mandatory managed care program for Medicaid enrollees. Under HealthChoice, eligible families and individuals are required to enroll in a managed care organization that has been approved by the Maryland Department of Health and Mental Hygiene. Each managed care organization is responsible for ensuring that HealthChoice enrollees have access to a network of medical providers that can meet the health needs of each enrollee.
The 2021 renewal; made the following changes to the demonstration:
- Created the MOM Model pilot initiative to reduce the burden of neonatal abstinence syndrome (NAS) and its associated costs, and improve maternal health outcomes, by providing case management along with somatic and behavioral care to pregnant people diagnosed with an opioid use disorder (OUD);
- Created a voluntary, five-year payment model in Annapolis, Baltimore City, and Montgomery counties, that provides greater flexibility to ambulance care teams to address emergency health care needs following a 911 call by allowing for payment for ground transports to alternative destinations such as urgent care providers in addition to the ED;
- Created an expenditure authority to cover Medicaid adults aged 21 to 64 that have an SMI diagnosis who are residing in a private IMD;
- Modified Maryland’s coverage of ASAM Level 4.0 to include not only providers located in Maryland, but also those based in contiguous states;
- Raised the participant spaces for the Assistance in Community Integration Services (ACIS) Pilot from 600 to 900; and
- Expanded the allowable time-frame of eligibility in the Healthy Families America (HFA) evidence-based Home Visiting Services (HVS) Pilot from age two to age three.
To review the Department's finalized §1115 demonstration waiver application that has been submitted to CMS, please review the resources below.
§1115 Waiver Renewal Resources (2021)
The Department accepted public comments from May 4, 2021, through June 4, 2021 and received comments from interested stakeholders, which may be found in Appendix B of the waiver application.
This year's public hearings were held via webinar to discuss the content of the waiver amendment and solicit feedback and input from public stakeholders on May 11, 2021 and May 27, 2021. Meeting information from both of the public hearings may be found below. The 2021 Post-Award Forum was held jointly with the second §1115 demonstration waiver renewal hearing on May 27, 2021 at 3:00 pm, via webinar. Meeting materials from the Post-Award Forum, which are the same as the materials from the first public hearing, may be found at the HealthChoice Post-Award Forum website.
Archival Information §1115 Waiver Renewal Application (2021) - Updated June 30, 2021
The Maryland Department of Health (the Department) has proposed to renew its §1115 demonstration waiver known as HealthChoice and submitted this application to the Centers for Medicare and Medicaid Services (CMS) on June 30, 2021.
§1115 Waiver Renewal Application (2021) - Updated May 4, 2021
The Maryland Department of Health (the Department) is proposing to renew its §1115 demonstration waiver known as HealthChoice.The Department intends to seek authorization to continue current pilots and programs permitted under the current §1115 waiver, as well to modify the Assistance in Community Integration Services Pilot, the Home Visiting Services Pilot, and the Residential Treatment for Substance Use Disorder program. In addition, the Department is seeking authorization for new programs, including the Expansion of IMD Services for Adults with Serious Mental Illness, the Maternal Opioid Misuse (MOM) Model, and the Emergency Triage, Treat and Transport (ET3) Model.
In FY 2020, there were 1,620,533 individuals enrolled in the Medicaid program, including 1,370,465 individuals in HealthChoice. This demonstration is not expected to increase or decrease annual enrollment.
Per the terms of the §1115 HealthChoice demonstration renewal as required by 42 CFR 431.420(c), the Department must conduct a post-award forum within six months of implementing the demonstration and annually thereafter. The forum is intended to provide the public with the opportunity to offer meaningful comments on the progress of the demonstration.
As of May 4, 2021, the State’s 30-day public comment period is open. The Department will accept comments through June 4, 2021. To review the Department’s draft §1115 demonstration waiver application, please click here.
§1115 Waiver Renewal Resources (2021)
Hard copies of the application may be obtained by calling (410) 767-5208. Interested parties may send written comments concerning the waiver amendment to Tricia Roddy, Deputy Medicaid Director, Office of Healthcare Financing, Maryland Department of Health, 201 West Preston Street, Room 224, Baltimore, Maryland 21201 or via email to mdh.healthchoicerenewal@maryland.gov. The Department will accept comments from May 4, 2021, through June 4, 2021.
The following public hearings will discuss the content of the waiver amendment and solicit feedback and input from public stakeholders. The 2021 post-award forum will be held jointly with the second §1115 demonstration waiver renewal hearing on May 27, 2021 at 3:00 pm, via webinar. The webinar registration and call-in information are found below. Meeting materials will be posted on the following website as the meeting date approaches:
https://mmcp.health.maryland.gov/healthchoice/Pages/HealthChoice-Post-Award-Forum.aspx.
Virtual Webinar and Audio Conference #1: §1115 Waiver Demonstration Renewal Application
Tuesday, May 11, 2021; 10:00 AM – 12:00 PM
Maryland Department of Health
GoToWebinar Virtual Platform
To participate in the public hearing via webinar, please register via: https://attendee.gotowebinar.com/register/2810866705598972683
Please note that if you desire to make a public comment, you will need to register via the link above. After registering, you will receive a confirmation email containing audio and visual information about joining the webinar.
Call-in number: (415) 655-0060
Access code: 610-004-077
The call-in number and access code presented above is for attendees who wish to join in listen-only mode.
Virtual Webinar and Audio Conference #2: §1115 Waiver Demonstration Renewal Application and HealthChoice Post Award Forum
Thursday, May 27, 2021; 3:00 PM – 5:00 PM
Maryland Department of Health
GoToWebinar Virtual Platform
To participate in the public hearing via webinar, please register via: https://attendee.gotowebinar.com/register/4831209426033221900
Please note that if you desire to make a public comment, you will need to register via the link above. After registering, you will receive a confirmation email containing audio and visual information about joining the webinar.
Call-in number: 1 (562) 247-8321
Access code: 415-369-968
The call-in number and access code presented above is for attendees who wish to join in listen-only mode.
§1115 Waiver Amendment (2020) - Updated May 5, 2020
The Department has proposed an amendment to its §1115 HealthChoice Demonstration Waiver to establish a limited Collaborative Care Pilot Program. The State’s 30-day public comment period was open from May 17, 2019 through June 16, 2019.
The approved §1115 HealthChoice Demonstration Waiver Amendment and Special Terms & Conditions (approved April 16, 2020) are available
here.
Please click here for more information on the HealthChoice Diabetes Prevention Program.
§1115 Waiver Amendment (2019)
The Department has proposed an amendment to its §1115 HealthChoice demonstration waiver to establish a limited Collaborative Care Pilot Program. The State’s 30-day public comment period was open from May 17, 2019 through June 16, 2019.
The draft waiver amendment is available
here; the final waiver amendment (as submitted on June 24, 2019) is available
here.
§1115 Waiver Amendment (2018)
The Department submitted an amendment to its §1115 demonstration waiver known as HealthChoice on July 2, 2018. The State’s 30-day public comment period was open from May 21, 2018 through June 19, 2018. CMS approved the 2018 waiver amendment in March 2019.
§1115 Waiver Amendment Resources (2018)
Baltimore City Public Stakeholder Meeting - May 24, 2018
Annapolis Public Stakeholder Meeting - June 6, 2018
§1115 Waiver Renewal Application (2016-17)
Effective January 1, 2017, the Centers for Medicare & Medicaid Services (CMS) approved and renewed Maryland's §1115 demonstration waiver, known as HealthChoice, for a period of five years.
HealthChoice, first implemented in 1997 under the authority of Section 1115 of the Social Security Act, is Maryland’s statewide mandatory managed care program for Medicaid enrollees. Under HealthChoice, eligible families and individuals are required to enroll in a managed care organization that has been approved by the Maryland Department of Health and Mental Hygiene. Each managed care organization is responsible for ensuring that HealthChoice enrollees have access to a network of medical providers that can meet the health needs of each enrollee.
The 2017 extension made the following changes to the demonstration:
- Created a Residential Treatment for Individuals with Substance Use Disorder (SUD) program as part of a comprehensive SUD strategy;
- Created two community health pilot programs:
- Evidence-based Home Visiting Services (HVS) pilot program to provide home visiting services for high-risk pregnant women and children up to two years of age; and
- Assistance in Community Integration Services (ACIS) pilot program to provide housing-related support services for high-risk, high utilizers who are either transitioning to the community from institutionalization or at high-risk of institutional placement;
- Raised the enrollment cap for the Increased Community Services program from 30 to 100; and
- Expanded dental benefits for former foster youth.
§1115 Waiver Renewal Resources (2016-17)
Please click here for information about the Community Health Pilots.
Please click here for more information on the Adult Dental Pilot Program.
Please click here for more information about the 2018 and 2019 §1115 HealthChoice Post-Award Forums.
Hard copies of waiver materials may be obtained by calling: (410) 767-1439.
For additional information or questions, please email mdh.healthchoicerenewal@maryland.gov.
