1915(i) Intensive Behavioral Health Services for Children,
Youth and Families


Over the past several years, Maryland has operated a special CMS demonstration project known locally as the Residential Treatment Center (RTC) Waiver.  This time limited demonstration project used a special authority granted by the federal government under Section 1915(c) of the Social Security Act to provide home and community-based services for children and youth with emotional disturbances and their families.  The demonstration project has now effectively reached its statutory end.    

In order to sustain and refine the approach undertaken in the initial CMS Demonstration Project, Maryland intends to apply for a 1915(i) State Plan Amendment (SPA) to serve a similar, but not identical, population of youth and families as prescribed by the federal government.   The service mix proposed is also similar to the initial demonstration, but has been refined and enriched, based on lessons learned from the process of implementing the original project.  ​

In addition to the full range of Medicaid somatic and behavioral health benefits available to all eligible individuals, participants enrolled in the proposed 1915(i) SPA will have access to a number of additional specialized services if they meet applicable medical necessity criteria. These specialized services and the proposed approach under which they will operate are described in the application.

The development of the 1915(i) program has led the department to create a new Mental Health Targeted Case Management service specifically designed to address the needs of children and youth. Participants currently receiving TCM services will continue to do so under the new program, which will include an additional level of care for those with intensive need such as 1915(i) participants. The Department obtained CMS approval effective October 1, 2014 for a SPA allowing this change. 

The 1915(i) and TCM state plan can be viewed on the Maryland Medicaid State Plan page​

1915(b)(4) Waiver Renewal Application (CMS approval effective 10/1/20) ​​Fee-for-service Selective Contracting for Mental Health Targeted Case Management​