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State reaches agreement with feds to allow Medicaid to pay for more services

Those leaving prison and jail in Maryland will be presumed eligible to sign up for Medicaid, the government-run health program for the poor, as part of a five-year agreement with federal authorities announced Tuesday.

Those leaving the corrections system are known to have higher rates of infectious and chronic diseases but often face hurdles securing Medicaid coverage for a number of reasons, including because some lack proper identification.


The change is one of several made under the state's new agreement with the U.S. Centers for Medicare and Medicaid Services, which waives certain rules to allow reimbursements that are not normally permitted under the program. It takes effect Jan. 1, though state officials said it's unclear whether the incoming Trump administration will seek to undo the agreement.

There are about 1.2 million people in the state's Medicaid plan, which operates as a managed care program called HealthChoice. About 260,000 residents were added to the rolls through an expansion under the federal health law known as Obamacare, and their status could be in jeopardy as some GOP lawmakers and Trump nominees for top health posts have signaled they want to dial back such growth.


The state and federal government split the cost of Medicaid, except for those added under Obamacare. The federal government pays the bulk of those expenses.

The idea behind such waivers from Medicaid rules is to improve access to health care for those with complex medical needs in cost-effective ways, according to the state Department of Health and Mental Hygiene. Some new provisions are considered budget neutral because they lead to cost savings, while others will require state money upfront and a federal match, according to state health officials.

"Maryland's Medicaid program recognized its 50th anniversary this year, and the initiatives in this waiver demonstrate that our state continues to be an innovator in delivering health care," said Dennis R. Schrader, the state health secretary, in a statement. "The components of this waiver could not be more timely or relevant."

Another provision of the agreement allows Medicaid to pay for some residential treatment for those with substance abuse disorders. Previously only outpatient programs were covered. That will be helpful in closing a gap in coverage, state officials said.

Reimbursement also will be allowed for dental coverage for former foster care youths up to age 26 and for some community health programs. One such program focuses on home visits for first-time mothers and mothers with high-risk pregnancies and their children.

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Baltimore City has cobbled together funding for such a program under its B'more for Healthy Babies initiative, which city Health Commissioner Dr. Leana Wen credits with lowering the infant mortality rate. She said qualifying for Medicaid reimbursement would give the program better financial stability.

She said generally that waiving the rules on several fronts will give localities greater flexibility in plugging holes in the health care system that were costing people their health and sometimes their lives.

"Public health has a huge return on investment that typically is not seen," Wen said.


In the cases of high-risk moms, recently incarcerated residents and those with substance abuse disorders, she added, "these are some of our most vulnerable residents and this can help to prevent them from falling through the cracks."

State Sen. Delores G. Kelley, a Baltimore County Democrat and member of Maryland's Medicaid Advisory Committee, also touted the new agreement.

"The renewal of the HealthChoice waiver includes initiatives that target Medicaid beneficiaries who are often exposed to negative health and social conditions, putting them at high risk for poor health outcomes," she said in a statement. "The Department's inclusion of limited housing support services and home visiting for pregnant women and children will leverage local expertise and resources, as well as evidence-based practices to build upon programs that address social determinants of health for vulnerable Marylanders."