What’s in store for Maryland’s Medicaid waiver renewal


Nicole Pasia


Over 1.4 million people under Maryland Medicaid, or the Health Choice program, will continue to receive care under the state’s 1115 waiver. The Centers for Medicare and Medicaid Services (CMS) approved the waiver’s extension last week for an additional five years, from Jan. 1, 2022 through Dec. 31, 2026. 

The current waiver, in place since 2016, will expire at the end of this year. In a letter to Maryland Department of Health (MDH) Secretary Dennis Schrader, CMS Deputy Administrator and Director Daniel Tsai outlined new programs approved for Medicaid beneficiaries, as well as additions to existing benefits. Here are a few to look out for: 


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New programs:


Expansion of IMD Services for Beneficiaries with Serious Mental Illness

To aid adult Medicaid beneficiaries with SMI or serious emotional disturbance (SED), the state will begin offering coverage for short-term stays (about 30 days) in inpatient treatment settings—or institutions of mental diseases (IMD)—starting after Jan. 1, 2022. The program will aim to reduce prolonged or unnecessary utilization of emergency departments for behavioral health services.

During their short-term residence, beneficiaries will be able to receive acute care or outpatient behavioral health services in community-based settings. The state will have 90 days to submit an implementation plan for this program with details on quality care metrics, continuation of care, and finances.


Maternal Opioid Misuse (MOM) Model

Substance use is a leading cause of maternal mortality in Maryland.  Approximately 1,500 children are born to Medicaid beneficiaries with a substance use disorder (SUD) each year statewide, according to CDC data. Since Jan. 2020, MDH has worked with CMS and other states to implement a coordinated system of care for postpartum beneficiaries with SUD. The state received $3.6 million for the program in 2020, and may receive another $1.5 million based on performance targets. 

Starting July 1, 2022, the state will provide managed care organizations (MCOs) with a per-member-per-month (PMPM) payment to provide services such as case management, health screenings, treatment plan options, and referrals to other services. The program will operate exclusively in St. Mary’s County until Dec. 2022, but is expected to expand statewide in Jan. 2023. 


Medicaid Alternative Destination Transport Pilot Program

Starting after Jan. 1, 2022, this pilot program will cover ground ambulance transportation to non-emergency department care facilities in four jurisdictions: Annapolis, Baltimore City, Charles County, and Montgomery County. 

Maryland Health Care Commission (MHCC) issued a report in 2019 that found 7.8% of emergency service transports were eligible for an alternative destination. The analysis also found an alternative destination program would reduce PMPM plan premiums by $0.02-$0.04, or $252,000 to $453,000 annually. 


Modifications to current benefits:


Assistance in Community Integration Service (ACIS) Pilot Program

ACIS, a home and community based service (HCBS) which provides supportive housing services to Medicaid beneficiaries, will increase its annual enrollment cap by 300 people. The program will now serve a total of 900 individuals. Supportive housing services include assistance with housing identification and application, disability accommodations, and budget assistance.


Home Visiting Services Pilot Program

Beginning Jan. 1, 2022, the state will increase the age of children covered under the program from two to three years. The program provides coverage for licensed-practitioners to perform home visits for pregnant women and their young children, improving health outcomes and promoting HCBS. By Dec. 31, 2022, this change will transition to a state plan amendment, according to the waiver. 


Residential Treatment for Individuals with SUD

The state will expand coverage for SUD treatment by removing any caps on length of stays at an inpatient care facility. However, the state will “aim for a statewide average length of stay of 30 days or less.”

More information about the waiver renewal can be found here. The state will have 30 days from the date of the renewal to provide written acceptance to CMS.