The Trump administration has approved a waiver request from Maryland, allowing the state to test several wellness and access projects in its Medicaid program.
Under the approval (PDF), the Centers for Medicare & Medicaid Services will allow Maryland to amend its Health Choice managed care program to test projects aimed at expanding access to substance abuse treatment, dental care and better managing diabetes.
Approved demonstrations must adhere to the goals of Medicaid, which is to offer medical assistance to low-income populations. In its letter, CMS said it determined that the various demonstrations included in the waiver request would likely improve access and boost 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 said.
The state’s initial diabetes care pilot expired on Jan. 1, so the waiver approval will allow it to further extend the demonstration. Under the Diabetes Prevention Program, patients will be paired lifestyle coaches who help them build and maintain healthy nutrition and fitness habits.
.@CMSGov just approved @MDHealthDept's amendment to the #Maryland HealthChoice #Medicaid demonstration designed to allow the state to expand access to prevention programs, dental services for certain adults, & higher level substance use disorder treatment. https://t.co/sLdOaFgXL1— Administrator Seema Verma (@SeemaCMS) March 18, 2019
In addition, the approval will allow Maryland to test a dental benefit for dual eligible beneficiaries between the ages of 21 and 65. The pilot would provide preventive and basic restorative dental care to this population, and in the letter, CMS highlighted the link between oral and physical health.
The waiver approval will also allow the state to grow its substance use disorder treatment coverage and grow its family planning program for women on Medicaid of childbearing age.
CMS has made state flexibility in Medicaid a priority under President Donald Trump, but the approach has been controversial, as work requirements in the program have been approved in eight states, most recently in Ohio.
The waiver is an amendment to the ongoing one-of-a-kind waiver that allows Maryland's all-payer payment model that aims to coordinate care between providers and promote patient outcomes. It was expanded by the Trump administration in 2018.
In defense of the section 1115 waivers, which includes both the work requirements and Maryland’s demonstration projects, CMS Administrator Seema Verma posted a fiery blog post and new guidance that aims to provide guardrails and monitoring tools to track how well these waivers are working.
In the post, Verma said the agency “recognizes that not everyone supports our efforts to prioritize local control.” The waivers, she said, offer a crucial opportunity to test new strategies in Medicaid.
“Through these efforts, we can collect and build an important body of evidence that will support continuous program improvement and new generations of good ideas,” she wrote.