1996.10.30 : Maryland Medicaid Health Care Reform Waiver Is Approved

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Date: Wednesday, Oct. 30, 1996
FOR IMMEDIATE RELEASE 
Contact: HCFA Press Office(202)6906145

Maryland Medicaid Health Care Reform Waiver Is Approved

HHS Secretary Donna E. Shalala announced that Maryland today becomes the 14th state to receive approval from the Clinton Administration for a comprehensive Medicaid reform demonstration project. The Maryland program will allow the state to enroll most beneficiaries in managed care plans. "President Clinton is committed to giving states the flexibility to test innovative programs that meet the needs of their citizens," Shalala said.

Gov. Glendening's plan will enable Maryland to bring most of its Medicaid beneficiaries into a preventionoriented system that will be held accountable for providing high quality care. The plan builds upon the strengths and managed care experience of the state's current health care system," Shalala added.

Innovations in the program include:

a special case management program for beneficiaries with rare and costly health care needs, such as pediatric AIDS; cystic fibrosis, and hemophilia;
mandatory inclusion in managed care networks of providers who have historically served Medicaid beneficiaries;
a rate setting system that adjusts for the financial risk to managed care plans by taking into account the diagnoses of individuals they enroll;
a mental health program delivered through a partnership of public and private agencies.

The state expects to enroll about 80 percent of its current Medicaid population, some 280,000 people, into managed care plans during the first six months of 1997.

Currently, 25 percent of Maryland Medicaid beneficiaries are voluntarily enrolled in HMOs, while another 50 percent participate in Maryland's feeforservice case management systemthe Maryland Access to Care program (MAC). Under the new program, MAC participants will be able to stay with their current primary care providers as long as those providers are part of a participating managed care plan.

Health Care Financing Administration Administrator Bruce Vladeck said of the waiver approval process: "This underscores the Clinton Administration determination to work closely with states, health care providers, advocates and beneficiaries to create the best possible managed care programs for Medicaid beneficiaries."

Beneficiaries in the new program will receive the same services as offered under the state's traditional feeforservice program. Mental health services will be provided through a separate feeforservice delivery system administered by the Mental Hygiene Administration. Those excluded from the demonstration project include "dual eligibles" for both Medicare and Medicaid, shortterm eligibles in "spend down" status, institutionalized individuals, and those in other waiver programs.

Maryland developed its proposal through an extensive public process that involved numerous public hearings, consumer forums, and weekly meetings of a 131member Waiver Advisory Committee made up of legislators, advocates, consumers, health care providers, and agency staff. A similar committee will continue to monitor the program throughout the demonstration.

Note: HHS press releases are available on the World Wide Web at: www.hhs.gov.