Upcoming changes to Maryland Medicaid ahead of post-PHE disenrollments

Maryland Medicaid stakeholders met on Thursday to discuss the program’s next steps in light of what could be the last extension of the federal public health emergency (PHE), which ends July 15. Once the PHE ends, so will the freeze on Medicaid disenrollments, causing many vulnerable Marylanders to lose their health coverage.

 

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“The message has been pretty clear that there will be no extension,” Deputy Medicaid Director Tricia Roddy told members of the Maryland Medicaid advisory committee at the meeting. “But, your guess is as good as mine. From our end, we will continue to operate like it will end on July 15th.”

Roddy shared data from the Department of Health (DOH) that showed the constant rise in Medicaid enrollments throughout the pandemic. As of April 27, there are over 1.7 million Medicaid enrollees in the state. This is an increase of over 286,000 people, or 20%, since February 2020. 

To prepare for the disenrollment process, the department has actively continued redetermining member eligibility and redirecting those who no longer qualify to the Maryland Health Connection, the state-based marketplace. 

Aside from the upcoming disenrollments, the department must implement several programmatic changes that came from the 2022 Legislative Session, which ended on April 11. According to Alyssa Brown, director of Innovation, Research, and Development at the Office of Health Care Financing, the legislature reviewed over 180 Medicaid-related bills. 

Notable bills that passed include House Bill 6/Senate Bill 150, which would require Medicaid coverage for adult dental services beginning Jan. 1, 2023. The department has started the process for administering services through its Healthy Smiles Program, which currently provides dental services for children. With change, the department will also begin to sunset the pilot program that previously provided Medicaid dental services for adults since 2019. The coverage expansion will only apply to fee-for-service providers. 

Another substantial bill that passed was SB 28/HB 80, which would task the department with reducing the existing waitlists and expanding capacity for home and community-based services (HCBS) waiver programs. 

Molly Marra, DOH Director of Maryland Medicaid Provider Services, provided additional updates to the waiver programs and other CMS regulations. Notably, the department is preparing to submit its Statewide Transition Plan to CMS by April 30th. This plan will outline how the department will bring all HCBS services in compliance with the 2014 CMS Settings Rule by March 2023. 

According to the department’s monthly waiver report, the rule will “maximize the opportunities for HCBS program participants to have access to community living and services in the most integrated setting.” 

Finally, the department updated stakeholders on the use of federal funds from the American Rescue Plan (ARP) to further supplement HCBS programs. The ARP provided an additional 10% FMAP to HCBS services from April 2021-March 2022, under the condition that these funds must be reinvested over the next three years. 

Maryland is dividing its ARP investments into three areas. First, approximately $128.4 million will go towards provider rate increases for long term services and supports (LTSS). About $188.8 million will support behavioral health services. The department is waiting on CMS approval to use $47.2 million of this portion for a certified peer recovery support services program for substance use disorders. Finally, $241 million is slated for the Developmental Disabilities Administration (DDA). The department is currently working on how to spend these dollars in the DDA, including one time payment supplements, competitive grants, and addressing administrative costs.