Federal government signs off on Maryland Medicaid’s waiver renewal
Efforts to expand substance-use treatment options, eligibility win approval

Annapolis, MD (December 27, 2016) – The Maryland Department of Health & Mental Hygiene announced today that the U.S. Centers for Medicare and Medicaid Services (CMS) has approved the state’s Medicaid Waiver renewal for its HealthChoice program. For the first time, the state was able to negotiate a five-year agreement with the federal government and will employ federal dollars through initiatives that will more closely align the program with the administration’s priorities to implement cost-effective strategies that improve access to health care and health for individuals with complex conditions and needs.
“In partnership with the federal government, this waiver offers innovative solutions to some of the issues facing Maryland’s health care system, and it will leverage federal dollars for substance-use treatment services as we continue to combat the opioid epidemic,” said Governor Larry Hogan.
“Maryland’s Medicaid program recognized its 50th anniversary this year, and the initiatives in this waiver demonstrate that our state continues to be an innovator in delivering health care,” said Health and Mental Hygiene Secretary Dennis R. Schrader. “The components of this waiver could not be more timely or relevant.”
“I applaud the efforts of our state and federal partners who continue to collaborate with us to deliver better care,” said Deputy Secretary Shannon McMahon, the state’s Medicaid Director. “Our hospitals, universities, advocates, providers, social services organizations, elected officials and – most important, our members – push us to explore new strategies to improve coverage.”
The waiver will take effect January 1, 2017, and includes several innovative initiatives that will allow Medicaid to pay for substance use services, and will allow local jurisdictions to address the social determinants of health for their most vulnerable individuals through locally managed programs. Key components of this agreement include:
  • Residential treatment for substance use disorders – The waiver will allow Maryland Medicaid to reimburse for residential substance use treatment services delivered in large facilities, known as Institutes for Mental Diseases.
  • Expanded dental care coverage for former foster care youths – The waiver also enables the state to extend its dental care coverage under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit for former foster care youths from up to age 21 to up to age 26.
  • Community health pilot program – This local initiative will blend federal Medicaid dollars with support from local jurisdictions to provide a set of limited home and community based services for individuals at imminent risk of institutional placement. This pilot will serve for 300 individuals.
  • Evidence-based home visiting for children and pregnant women – This second local initiative will enable Maryland Medicaid to work with local government entities to deliver at least one of two evidence-based models of home care for children and pregnant women. These programs focus on the health of first-time mothers, mothers with high-risk pregnancies and their children.
  • Increased community services program – Maryland is raising the community services program’s cap on participants from 30 to 100 people. The program assists very-low-income people who live in nursing home facilities to move into their communities and to retain a part of their income.
  • Presumptive eligibility for individuals leaving jail or prison – Through its waiver negotiation, the federal government has authorized Maryland to pursue presumptive eligibility for individuals leaving jail or prison through its Medicaid State Plan. In coming weeks, Maryland will amend its Medicaid State Plan to create this eligibility option, which will supplement Maryland Medicaid’s current jail enrollment and care coordination strategy.
“This gives the state another avenue to reach and to enroll Medicaid-eligible individuals in the correctional system – ensuring  access to necessary physical and behavioral health services upon release,” said Deputy Secretary McMahon. “Individuals leaving jail or prison often have higher rates of chronic and infectious diseases; this effort is clearly aligned with the administration’s priority on justice reinvestment, and we are pleased that the federal government is partnering with us.”
“With this new authority, our efforts to address the opioid epidemic within the state have significantly expanded.” said Lt. Governor Boyd K. Rutherford. “This waiver helps the State fill a much-needed gap in the continuum of care for substance use treatment. Currently, the state cannot utilize federal dollars to pay for residential substance use treatment, which severely hampers our ability to ensure people have access to a full array of substance use treatment.”
“The renewal of the HealthChoice waiver includes initiatives that target Medicaid beneficiaries who are often exposed to negative health and social conditions, putting them at high risk for poor health outcomes,” said state Sen. Delores G. Kelley (D-Baltimore County), a member of Maryland’s Medicaid Advisory Committee.  “The Department’s inclusion of limited housing support services and home visiting for pregnant women and children will leverage local expertise and resources, as well as evidence-based practices to build upon programs that address social determinants of health for vulnerable Marylanders.”