​Pilot Overview

Beginning in 2017, the Maryland Department of Health (MDH) received approval by the Centers for Medicare and Medicaid Services (CMS)  to administer a pilot program aimed to address health related social needs, specifically related to housing. This pilot, under the authority of Maryland’s §1115 HealthChoice Waiver, delivers housing and tenancy based services to qualifying individuals experiencing housing insecurity. Currently this pilot operates only within Baltimore City, Cecil County, Montgomery County, and Prince George’s County. The ACIS pilot is effective through December 31, 2026. See this link for ongoing reports, completed by The Hilltop Institute. 

Enrollment and Eligibility

As of June 2023, Maryland has allocated 620 of the 900 ACIS participant spaces to local governmental agencies, known as Lead Entities. 

• Baltimore City Mayor’s Office of Homeless Services- 300 spaces
• Cecil County Health Department- 15 spaces
• Montgomery County Health and Human Services- 230 spaces
• Prince George’s County Health Department- 75 spaces
  

In order to be eligible for this program, a Medicaid participant must meet the needs-based criteria as specified below:

1.   Health criteria (at least one)

1. Repeated incidents of emergency department (ED) use (defined as more than four visits per year) or hospital admissions; or
2. Two or more chronic conditions as defined in §1945(h)(2) of the Social Security Act

2.   Housing Criteria (at least one)

1. Individuals who will experience homelessness upon release from the settings defined in 24 CFR 578.3; or
2. Those at imminent risk of institutional placement
   

Eligible enrollees within the program are able to receive housing and tenancy based services, reimbursed on a bundled payment basis. The rates are determined and negotiated as part of an annual process during a fixed budget review. 

Funding

ACIS Pilot costs are an equal combination of local dollars and federal funds. No costs are provided by the State of Maryland. Up to $3.6 million in matching federal funds are available annually, and when combined with the local non-federal share, ACIS Pilot expenditures may total up to $7.2 million annually.

ACIS Lead Entities are eligible for reimbursement upon the delivery of a minimum of three services per month to each member per month. This mechanism allows ACIS providers to earn back their local dollars as well as the federal matching dollars.

Applications and Expansion

ACIS Pilot Lead Entity applications will be accepted on a rolling basis until the 280 remaining spaces are awarded. Applications must be completed by a local government entity, such as a local health department or local management board, and adhere to the terms listed within the HealthChoice waiver.  

The full technical terms and conditions can be found here under the CMS Special Terms and Conditions (STCs) for the HealthChoice Medicaid §1115 Demonstration (No. 28 and 29). Attachment F of the STCs serves as the ACIS Pilot Protocol and provides additional information for pilot operations.