The Maryland Department of Health (MDH) invited interested lead local government entities to apply for federal matching funds available for the Assistance in Community Integration Services (ACIS) Pilot through a service expansion initiative of the State of Maryland’s Medicaid §1115 HealthChoice Waiver. From August through November 2017, MDH requested and reviewed applications for federal matching funds for ACIS Pilot programs to serve high-risk, high-utilizing Medicaid enrollees who are at risk of institutional placement or homelessness post-release from certain settings. In November 2017, Round One awards were granted to three Lead Entities to serve a maximum of 190 individuals. In April 2018, Round Two awards were granted to one new Lead Entity and one existing Lead Entity to serve an additional 110 individuals annually.
In July 2018, MDH submitted a §1115 Waiver Amendment to the Centers for Medicare and Medicaid Services (CMS) in part requesting an additional 300 participant places for the ACIS Pilot, bringing the total cap to 600 individuals annually. CMS approved this expansion in April 2019.
In July 2019, Round Three awards were granted to one existing Lead Entity to serve an additional 100 individuals annually. As of August 1, 2019, 200 statewide ACIS beneficiary spaces remain.
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. This renewal raised the total participant spaces for the Assistance in Community Integration Services (ACIS) Pilot from 600 to 900.
The statewide competition is now open to all qualified applicant organizations, as well as to those qualified organizations participating in the first, second, or third rounds of the ACIS Pilot initiative that seek to further expand their delivery of ACIS services. As of August 9, 2019, the Maryland Department of Health will begin accepting ACIS Pilot applications on a rolling basis. Applicants will be reviewed and awarded funding in the order in which they apply. Applicants must complete the full application and meet applicant requirements to be considered for award. To date, 420 spaces have been awarded across the four current Lead Entities. The rolling application process will remain open until the remaining 480 ACIS participant spots are filled.
ACIS Pilot programs provide a set of home- and community-based services (HCBS) to a population that meets the needs-based criteria specified below, capped at 900 individuals annually.
The state’s needs-based criteria are specified below.'
1. Health criteria (at least one)
- Repeated incidents of emergency department (ED) use (defined as more than four visits per year) or hospital admissions; or
- Two or more chronic conditions as defined in §1945(h)(2) of the Social Security Act
2. Housing Criteria (at least one)
- Individuals who will experience homelessness upon release from the settings defined in 24 CFR 578.3; or
- Those at imminent risk of institutional placement
The ACIS Pilot application must be completed by a lead local government entity (Lead Entity), such as a local health department or local management board, with the ability to fund fifty percent of ACIS Pilot costs with local dollars through an intergovernmental transfer (IGT) process. Lead Entities are also required to provide leadership and coordinate with key community partners to deliver the ACIS Pilot program. The ACIS Pilot is effective from July 1, 2017 through December 31, 2021 and is scheduled to be funded for the 4½ years duration of the waiver.
Up to $4.8 million in matching federal funds are available annually, and when combined with the local non-federal share, ACIS Pilot expenditures may total up to $9.6 million annually. ACIS providers are required to provide a minimum of three services per month to each member to receive reimbursement in a given month. MDH will then pay the Lead Entity for the ACIS services per the monthly ACIS cost-based rate, which shall be the average cost of the total of a minimum of three ACIS tenancy-based case management services/tenancy support services and housing case management services.
Pilot award payments shall support delivery of the aforementioned ACIS services. ACIS payments shall not exceed the amount expended by the Lead Entity for furnishing for the direct service costs incurred by the provider.
General details of the ACIS Pilot’s parameters can be found in the CMS Special Terms and Conditions (STCs) for the HealthChoice Medicaid §1115 Demonstration (No. 28 and 29). Attachment E of the STCs provides additional information about the ACIS Pilot program. Details of the ACIS Pilot Program's 2019 expansion parameters can be found here.
Resources and Information
As of August 9, 2019, ACIS Pilot applications will be accepted on a rolling basis until the remaining 480 statewide ACIS participant spaces have been awarded.
ACIS Pilot Application Materials - Rolling Deadline
Round 3 Archive
Round 2 Archive
Round 1 Archive
CMS Final Special Terms and Conditions (STCs)