1. Presenter: Kaylee O’Connor, MSPH Candidate Preceptors: Sandy Kick, MSPH Administrative Program Manager II Brendan Loughran, MA Health Policy Analyst May 6, 2016 1

2.  Introduction & Project Overview  Waiver Structure  Professional Development  Proposed Program Expansions & Demonstrations  The Process  Conclusion  Lessons Learned  Policy & Practice Implications  Acknowledgements  References  Questions 2

3. 3

4.  Maryland Medicaid  Covers over 1 million people  §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  The Project = The Renewal 4

5.  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 5

6.  Meetings  Maryland Health Benefit Exchange  Standing Advisory Committee  Health Services Cost Review Commission (HSCRC)  State Innovation Model (SIM) teleconferences  Webinars 6

7. 1. Residential Treatment for Individuals with Substance Use Disorders 2. Community Health Pilots: Limited Housing Support Services & Evidence-Based Home Visiting for High Risk Pregnant Women and Children Up to Age 2 3. Transitions for Criminal Justice Involved Individuals 4. Dental Expansion for Former Foster Youth 5. Increased Community Services Program 7

8.  The Amendment Request  July 27, 2015  Asked for residential treatment for SUD & mental health  Maryland Modified – requested residential treatment for SUD only  50% federal match  Reimbursements mean treating more patients 8

9. 1. Limited Housing Support Services  Health policy meeting in Washington, D.C.  Tenancy Support & Transitional Services  High risk, high utilizing Medicaid beneficiaries 2. 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 9

10.  Pre-enrollment  Eligible following ACA  Continuity of healthcare  Reduce recidivism & state expenditures  NASHP & peer learning phone calls  Presumptive Eligibility 10

11.  State’s legislative session  Weekly legislative briefing meetings  Enactment of Senate Bill 252  Dental expansion for former foster youth up to age 26 11

12.  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 12

13.  CMS’s Proposed Managed Care Regulations  The Curveball - Approved April 26 th  Budget Neutrality  Met with Medicaid Financing – coding & eligibility  The Public Notice  Announced waiver changes & public hearings  Published in the Baltimore Sun, The Maryland Register & DHMH Website  30-day public comment period 13

14.  Completed the draft  Posted for public comment on April 29th  Currently in the public comment period  Will run until May 30 th  Compile stakeholder comments  Submit to CMS 14

15.  Flexibility  Moving Parts  Timeline  Preparation  Organization, Drafting & Communication  Google Drive  Teamwork  Relying on others  Knowing who to go to 15

16.  Apply classroom knowledge to the real world  The jargon  Alternative Payment Models  Interaction of Policy & People  State government decisions and implications 16

17.  Preceptors  Sandy Kick & Brendan Loughran  The Rest of the Planning Administration / Medicaid Team  Alice Middleton, Tricia Roddy, Eugene Simms, Alyssa Brown, Laura Goodman & everyone else  PHASE  Paulani Mui & Beth Resnick 17

18. 1. 1. http://msa.maryland.gov/msa/mdmanual/16dhmh/pdf/16dhmh.pdf 1. http://msa.maryland.gov/msa/mdmanual/16dhmh/pdf/16dhmh.pdf 2. 2. https://www.medicaid.gov/medicaid-chip-program-information/by-state/maryland.html 2. https://www.medicaid.gov/medicaid-chip-program-information/by-state/maryland.html 3. Maryland HealthChoice Program 1115 Waiver Renewal Application. (2016, July 1). Retrieved April 19, 2016, from https://mmcp.dhmh.maryland.gov/Pages/1115-HealthChoice-Waiver- Renewal.aspx 4. 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-health- coverage/CCJH Webinar 5. http://www.baltimoresun.com/news/maryland/bal-black-guerrilla-family-tavon-white-prison- corruption-20130425-htmlstory.html http://www.baltimoresun.com/news/maryland/bal-black-guerrilla-family-tavon-white-prison- corruption-20130425-htmlstory.html 6. http://www.bizjournals.com/philadelphia/news/2015/11/05/pa-nursing-home-workers-wages- medicaid-keystone.html 7. Maryland HealthChoice Program 1115 Waiver Renewal Application. (2016, July 1). Retrieved April 19, 2016, from https://mmcp.dhmh.maryland.gov/Pages/1115-HealthChoice-Waiver- Renewal.aspx 8. Ibid. 9. Ibid. 10. http://mgaleg.maryland.gov/2016RS/fnotes/bil_0002/sb0252.pdf http://mgaleg.maryland.gov/2016RS/fnotes/bil_0002/sb0252.pdf 11. http://dhmh.maryland.gov/docs/Maryland%20Section%201115_IMD%20Exclusion%20Waiver% 20Application.pdf 12. http://dhmh.maryland.gov/docs/Maryland%20Section%201115_IMD%20Exclusion%20Waiver% 20Application.pdf 18

19. 19