CMS Approves Medicaid 1115 Waiver in Maryland

March 21, 2019 - CMS has approved Maryland’s section 1115 waiver application for a demonstration to expand access to diabetes care, substance abuse services, and other healthcare services for Medicaid beneficiaries in Maryland.  

The agency passed the amendment after evaluating state and federal comments, all of which expressed support for the proposed changes. The approval became effective on March 18, 2019 and will last through December 31, 2021.  

“We are committed to supporting states that seek to test policies that are likely to improve beneficiary health, because we believe that promoting independence and improving health outcomes is in the best interests of the beneficiary and advances the fundamental objectives of the Medicaid program,” CMS stated.

“Policies designed to improve beneficiary health that lower program costs make it more practicable for states to make improvements and investments in their Medicaid program and ensure the program's sustainability so it is available to those who need it most.”

The amendment approval authorizes Maryland to carry out the HealthChoice Diabetes Prevention Program (DPP), which is modeled after the National Diabetes Prevention Program . DPP is open to individuals aged 18 to 64 and who have pre-diabetes or are at high risk of developing type 2 diabetes.

Lifestyle coaches will deliver the program services through in-person and online models that align with CDC standards, and Maryland policymakers will assess the program’s effects on healthcare utilization.

“The state will test the impact DPP has on all-cause hospital admission, medications, total cost of care, incidence of diabetes, and utilization of emergency medicine services,” CMS said.

The amendment also includes the expansion of substance use disorder (SUD) residential services, which will enable the state to extend coverage of Medically Managed Intensive Inpatient Services (ASAM Level 4.0) for up to 15 days per month.

The coverage will extend to individuals between the ages of 21 and 64 who are residing in institutions for mental conditions and have a primary SUD diagnosis and a secondary mental health diagnosis. The state will determine whether this expansion affects existing quality and cost measures.

In addition to diabetes and substance use services, the amendment will establish an adult dental pilot program to expand access to oral care.

“To date, the state does not provide non-emergency dental services to the dual eligible population,” CMS said.

“The adult dental pilot program is a limited dental pilot program for full dually eligible adults 21 through 64. The adult dental pilot program will offer basic dental services that includes diagnostic, preventive, extraction, and limited restorative dental services.”

The amendment will expand home- and community-based services as well. The demonstration project will expand Maryland’s Assistance in Community Integration Services (ACIS) pilot program, which offers a set of home- and community-based services to beneficiaries that meet ACIS needs-based criteria.

“In 2016, the ACIS pilot program was approved and capped at 300 individuals annually,” CMS wrote.

“Given the interest in this pilot program, the state sought authority to expand the enrollment cap to 600 individuals annually.”

Maryland will also modify its family planning program with the new amendment. Women of childbearing age who have a family income at or below 200 percent of the federal poverty line, and who aren’t eligible for Medicaid, CHIP, or Medicare but had Medicaid pregnancy coverage, will now be eligible for the family planning program.

Eligibility will extend for 12 months after the two-month post-partum period.

CMS expects that the approval of this amendment will increase Medicaid beneficiary access to care and specialty services, and improve patient outcomes.

“CMS has determined this amendment is likely to promote Medicaid objectives, and the expenditure and waiver authorities sought are necessary and appropriate to carry out the demonstration,” the agency concluded.

“The Secretary has determined that the Maryland HealthChoice section 1115 demonstration, as amended, is likely to assist in promoting the objectives of the Medicaid program.”