Maryland Medicaid and SCHIP Waivers

Section 1115 Waiver – In 1996, Maryland received approval from the Centers for Medicare and Medicaid Services (CMS) to implement a statewide mandatory managed care program, HealthChoice [1], under the authority of a section 1115 waiver. The main goals of the program are to control rising Medicaid costs and to improve care coordination. The HealthChoice waiver has undergone two renewals and numerous amendments.  HealthChoice expansion initiatives include: the Family Planning Program, Employed Individuals with Disabilities, and the Maryland Primary Adult Care program. The Employed Individuals with Disabilities program, implemented in April 2006, provides full Medicaid coverage to individuals with disabilities with incomes up to 300 percent of the federal poverty level (FPL). Program enrollment reached 160 individuals in November 2007.  Under the Maryland Primary Adult Care (PAC) program, adults over the age of 19 with incomes up to 116 percent of the FPL, who are ineligible for Medicaid and Medicare, receive primary care, outpatient mental health, and pharmacy services. The Maryland Primary Adult Care program began enrollment in July 2006.  As of December 2007, more than 28,000 adults were enrolled in PAC.

On November 19, 2007, Governor Martin O’Malley (D) signed the Working Families and Small Business Health Coverage Act [2] that will expand Medicaid eligibility up to 116 percent of the Federal Poverty Level (FPL) for parent and caretaker relatives with a dependent child living at home. The legislation also called for a four year phase-in of Medicaid eligibility up to 116 percent FPL for childless adults. Enrollment may be capped and benefits may be limited based on available funding. The state of Maryland expects to seek approval from CMS for this expansion in the spring of 2008.