5 Things Maryland: New Medicaid programs, MHA policy priorities, Health expenditures


Eli Kirshbaum


In case you missed it, last week we released the Topical Agenda for the 2022 State of Reform Federal Health Policy Conference. The event is coming up on February 17 and will be fully virtual, allowing attendees from across the country to participate!

This conference will feature conversations on federal health policy, innovations in the state-federal relationship, and learning labs for state-level successes. If you already know you want to join us, be sure to register here.

Emily Boerger
State of Reform


1. MHA to prioritize workforce supports in the 2022 session

Early in the pandemic, the state’s all-payer model acted as a “shock absorber” to stabilize hospitals amidst a drop in patient volume and an increase in expenses for personal protective equipment, says Nicole Stallings, chief external affairs officer at the Maryland Hospital Association. But now, hospitals are facing a significant workforce shortage—one that Stallings says the model can’t solve.

Stallings says MHA’s legislative priorities for the upcoming session include securing immediate, short-term relief to address the hospital workforce shortage, either through legislation or budget amendments. “[MHA] would like to create a fund that hospitals can use for recruitment and retention of their health care staff to ensure that we can continue to provide care to those that we’re seeing in every [COVID] surge.” Another top priority, she says, is to increase medical liability protections.

2. New programs approved in Medicaid waiver

CMS approved Maryland’s 1115 waiver renewal request earlier this month, putting in place three new programs for Medicaid beneficiaries along with several modifications to current benefits. The new programs include the Medicaid Alternative Destination Transport Pilot Program—which will cover ambulance transportation to non-emergency department care facilities in four jurisdictions—and expanded services for beneficiaries with serious mental illness/serious emotional disturbance.

The waiver renewal also granted approval for expenditures to provide services under the Maternal Opioid Misuse (MOM) Model Pilot Program. Through the waiver, the state will increase the number of beneficiaries who can receive supportive housing services under the Assistance in Community Integration Services program. The state will also increase the age of children who can be served under the Home Visiting Services Pilot Program.


3. ‘Hyper local responses’ crucial to public health

In a report released earlier this year, Dr. Stephen Thomas, director of the Maryland Center for Health Equity, and other researchers identified several barriers and challenges that contributed to COVID-related health disparities in Prince George’s County. A key lesson learned, he says, is the importance of developing hyper local public health responses that take into account history and cultural nuances.

“We learned hyper local responses to the pandemic get better health outcomes. You can’t just do a nationwide blanket message or communication … part of that hyperlocal [response] is understanding what the history is in that particular zip code.” He discussed the findings of the report, recommendations for the future, and public health policy in this conversation with State of Reform.

4. Q&A: Rebecca Canino of Johns Hopkins Telemedicine on the future of telehealth

Telehealth use in Maryland has skyrocketed due to COVID-19 and is used by every specialty of medicine in the state, according to Rebecca Canino, administrative director of Johns Hopkins Telemedicine. Despite emphasizing the benefits of the Preserve Telehealth Access Act, Canino denounced the state’s removal of a rule that waived licensure requirements during the pandemic and allowed individuals from other states to see their Maryland provider remotely.

In this Q&A, Canino says this decision especially impacts out-of-state individuals who rely on Maryland providers for specialty care and “is really limiting patients in who they can see and how they can see them.” She urges the adoption of interstate agreements like a Mid-Atlantic Medical Excellence Zone as well as the federal TREAT Act to ameliorate the issue


5. 9.7% increase in US health expenditures in 2020

CMS’s annual report on national health spending found that total health expenditures in the United States reached $4.1 trillion during 2020—a 9.7% increase over the 2019 level of $3.8 trillion. This combined with the overall shrinking of the U.S. economy means national health expenditures (NHE) were equal to 19.7% GDP last year.

The increase was driven by the federal government’s pandemic response, not patients using more services, writes Jim Capretta in a recent column. In Medicaid alone, federal expenditures increased by 19% in 2020. State & local government health spending declined 3.1% compared to 2019. Private business spending on health care also declined 3.1%. The report found there was a net reduction in the number of uninsured Americans, declining from 31.8 million in 2019 to 31.2 million in 2020.