Medicaid seeks federal waiver to provide residential substance-use treatment
Effort would ensure coverage for residents upon their release from jail
Baltimore, MD (June 30, 2016) – Today, the Maryland Department of Health and Mental Hygiene submitted a waiver renewal application for HealthChoice – Maryland’s statewide, mandatory Medicaid managed care program. The goal of the requested policy innovations is to break cycles of addiction and disease affecting our communities.
“If the federal government approves our application, the State will be well-positioned to substantially improve access to residential substance-use treatment for our most vulnerable Marylanders,” said Secretary Van T. Mitchell. “The waiver will achieve cost savings for both the state and federal governments by enabling Medicaid to pay for medically necessary, substance-use treatment in appropriate health care settings.”
HealthChoice is designed to manage costs, to enhance service utilization and to increase healthcare quality for nearly 1.1 million Medicaid participants. Since its inception in 1997, HealthChoice has achieved substantial savings. Consistent with Maryland Governor Larry Hogan’s priority of promoting equal access to high-quality health care services for all Marylanders, the state is seeking federal support of initiatives that would increase access to care, would enhance care coordination and would establish a stable foundation on which to deliver evidence-based services in several areas – including the provisions of residential treatment for individuals with substance-use disorders and of improved transitions of individuals with criminal justice involvement back to their respective communities.
Residential treatment for substance-use disorders
Governor Hogan and his administration have prioritized the development of comprehensive responses to Maryland’s opioid epidemic. Presently, federal dollars are not available to support substance-use disorder treatment for individuals receiving care in Maryland residential facilities, because of the Institutions for Mental Disease (IMD) Exclusion. The federal IMD Exclusion prohibits Medicaid reimbursement for adults between the ages of 21 and 64 who are receiving services in “a hospital, nursing facility or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases – including medical attention, nursing care and treatment of individuals with mental diseases.”
Maryland is asking the federal Centers for Medicare and Medicaid Services (CMS) for a waiver of those rules to allow Medicaid funds to cover a continuum of evidence-based, residential substance-use services provided in our communities. Maryland is one of the first states in the country to initiate this request of the federal government and has been in active negotiations with CMS to ensure these critical services are available to Medicaid participants. The HealthChoice waiver must be renewed every three years with CMS; states often use renewal periods to enhance or tweak their Medicaid programs.
Transitions for criminal justice-involved individuals
Governor Hogan’s priorities also have included reducing recidivism and identifying better ways to supervise justice-involved individuals. The Governor’s Office of Crime Control and Prevention convened the Justice Reform Coordinating Council to develop a justice reinvestment process in line with these goals. As a result of the Council’s work, the Justice Reinvestment Act was passed in this year’s legislative session.
Connecting eligible individuals to Medicaid coverage upon release is a key component of the Act, and the state is seeking a waiver to provide presumptive eligibility – a pathway to longer-term Medicaid coverage through an on-site eligibility determination – for individuals leaving jails and prisons in the state. “Presumptive eligibility is the first step to ensuring that individuals have health care coverage when they leave jail,” said Shannon McMahon, Health and Mental Hygiene Deputy Secretary for Health Care Financing, which houses Maryland’s Medicaid program. “We recognize that additional work must be done to ensure individuals leaving jail with a Medicaid card are connected to needed care as they reenter the community. We have already started to lay the groundwork and are working with our partners across state government, managed care and community organizations, as well as with health care providers, to make these critical connections.”
Pilots for strengthening local communities
The waiver application also seeks federal matching funds for two pilot programs that are designed to help Maryland’s local communities address social determinants of health:
·         The first pilot would support local efforts to provide services through two evidence-based, home-visiting model programs – the Nurse-Family Partnership and Healthy Families America. The models focus on high-risk pregnant women and their children.
·         The second pilot program would provide limited housing support services to a limited number of Medicaid participants statewide.
Other items in the waiver include program enhancements to the Increased Community Services program and a request to provide dental coverage for former foster youth, based on legislation enacted in the 2016 session. For more information about the administration’s waiver renewal, go to the Health and Mental Hygiene website:
Marylanders who need help finding substance abuse treatment resources should visit or call the Maryland Crisis Hotline, which provides 24/7 support, at 1-800-422-0009. For information on many of the policies currently implemented to fight addiction and overdose in Maryland, see If you know of someone who could use treatment for substance abuse, treatment facilities can be located by location and program characteristics on our page at