Presenter:
Kaylee O’Connor, MSPH Candidate
Preceptors:
Sandy Kick, MSPH
Administrative Program Manager II
Brendan Loughran, MA
Health Policy Analyst
May 6, 2016
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Introduction & Project Overview
Waiver Structure
Professional Development
Proposed Program Expansions & Demonstrations
The Process
Conclusion
Lessons Learned
Policy & Practice Implications
Acknowledgements
References
Questions
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Maryland Medicaid
 Covers over 1 million people
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§1115 HealthChoice Waiver
 Mandatory managed care program
 8 managed care organizations
 Covers 80% of state Medicaid
population
 Established in 1997 under §1115
of the Social Security Act
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The Project = The Renewal
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Submit by July 1, 2016
 History
 Special initiatives for the latest renewal period
 List of requested changes
 Requested waiver and expenditure authorities
 Budget neutrality request
 Public input
 HealthChoice evaluation
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Meetings
 Maryland Health Benefit Exchange
 Standing Advisory Committee
 Health Services Cost Review Commission
(HSCRC)
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State Innovation Model (SIM) teleconferences
Webinars
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1. Residential Treatment for Individuals with
2.
3.
4.
5.
Substance Use Disorders
Community Health Pilots: Limited Housing
Support Services & Evidence-Based Home
Visiting for High Risk Pregnant Women and
Children Up to Age 2
Transitions for Criminal Justice Involved
Individuals
Dental Expansion for Former Foster Youth
Increased Community Services Program
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The Amendment Request
 July 27, 2015
 Asked for residential
treatment for SUD &
mental health
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Maryland Modified –
requested residential
treatment for SUD only
 50% federal match
 Reimbursements mean
treating more patients
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Limited Housing Support Services
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2.
Health policy meeting in Washington, D.C.
Tenancy Support & Transitional Services
High risk, high utilizing Medicaid beneficiaries
Evidence-Based Visiting for High Risk
Pregnant Women and Children Up to Age 2
 Nurse Family Partnership & Healthy Families
America
 Funds produced from local entities
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Pre-enrollment
 Eligible following ACA
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Continuity of healthcare
 Reduce recidivism & state expenditures
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NASHP & peer learning phone calls
Presumptive Eligibility
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State’s legislative
session
 Weekly legislative
briefing meetings
 Enactment of Senate Bill
252
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Dental expansion for
former foster youth up
to age 26
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Individuals with incomes above 300% of SSI
can move back into the community
Meetings with Long Term Services and
Supports
30 slots expanding to 100
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CMS’s Proposed Managed Care Regulations
 The Curveball - Approved April 26th
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Budget Neutrality
 Met with Medicaid Financing – coding &
eligibility
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The Public Notice
 Announced waiver changes & public hearings
 Published in the Baltimore Sun, The Maryland
Register & DHMH Website
 30-day public comment period
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Completed the draft
Posted for public comment on April 29th
Currently in the public comment period
 Will run until May 30th
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Compile stakeholder comments
Submit to CMS
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Flexibility
 Moving Parts
 Timeline
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Preparation
 Organization, Drafting & Communication
 Google Drive
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Teamwork
 Relying on others
 Knowing who to go to
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Apply classroom
knowledge to the real
world
 The jargon
 Alternative Payment
Models
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Interaction of Policy
& People
 State government
decisions and
implications
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Preceptors
 Sandy Kick & Brendan Loughran
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The Rest of the Planning Administration /
Medicaid Team
 Alice Middleton, Tricia Roddy, Eugene Simms,
Alyssa Brown, Laura Goodman & everyone else
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PHASE
 Paulani Mui & Beth Resnick
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1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
1.
http://msa.maryland.gov/msa/mdmanual/16dhmh/pdf/16dhmh.pdf
2. https://www.medicaid.gov/medicaid-chip-program-information/by-state/maryland.html
Maryland HealthChoice Program 1115 Waiver Renewal Application. (2016, July 1). Retrieved
April 19, 2016, from https://mmcp.dhmh.maryland.gov/Pages/1115-HealthChoice-WaiverRenewal.aspx
Zemel, S., Cardwell, A., & Corso, C. (2015, November 16). Toolkit: State Strategies to Enroll
Justice-Involved Individuals in Health Coverage - NASHP. Retrieved April 18, 2016, from
http://www.nashp.org/toolkit-state-strategies-to-enroll-justice-involved-individuals-in-healthcoverage/CCJH Webinar
http://www.baltimoresun.com/news/maryland/bal-black-guerrilla-family-tavon-white-prisoncorruption-20130425-htmlstory.html
http://www.bizjournals.com/philadelphia/news/2015/11/05/pa-nursing-home-workers-wagesmedicaid-keystone.html
Maryland HealthChoice Program 1115 Waiver Renewal Application. (2016, July 1). Retrieved
April 19, 2016, from https://mmcp.dhmh.maryland.gov/Pages/1115-HealthChoice-WaiverRenewal.aspx
Ibid.
Ibid.
http://mgaleg.maryland.gov/2016RS/fnotes/bil_0002/sb0252.pdf
http://dhmh.maryland.gov/docs/Maryland%20Section%201115_IMD%20Exclusion%20Waiver%
20Application.pdf
http://dhmh.maryland.gov/docs/Maryland%20Section%201115_IMD%20Exclusion%20Waiver%
20Application.pdf
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