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Maine Section 1115 HIV Demonstration Evaluation Design

Overview

In April 2019, the Maine Medicaid Section 1115 Demonstration for Individuals with HIV/AIDS was granted a 10-year approval from the Centers for Medicare and Medicaid Services (CMS). This waiver has been operational since July 1, 2002, and it provides a defined set of MaineCare services to individuals living with HIV/AIDS who have an individual income equal to or less than 250% of the Federal Poverty Level (FPL) and are not otherwise eligible for MaineCare. This waiver is designed to provide more effective, early treatment of HIV by making available a limited but comprehensive package of services, including antiretroviral therapies. The State believes that early treatment and care management services provided to individuals with HIV/AIDS create efficiencies that allow MaineCare to help individuals maintain access to critical treatments, keeping the disease from progressing.

This waiver aims to improve the health status of individuals living with HIV/AIDS in Maine by:

  • Improving access to continuous healthcare services;
  • Arresting progression of HIV/AIDS status by providing early and optimal care coupled with high quality and cost efficiency; and
  • Using the savings generated from disease prevention and the delayed onset of AIDS to expand coverage to additional low-income individuals living with HIV.

On January 21, 2020, the CMS approved Maine's evaluation design for this demonstration titled "Maine Medicaid Section 1115 Health Care Reform Demonstration for Individuals with HIV/AIDS" (Project Number 11-W-00128/1) effective through December 31, 2028. This document is being published per 42 CFR 431.424(c).


IMD Exclusion for SUD

Overview

The State of Maine’s Department of Health and Human Services is seeking waiver authority under Section 1115 to claim Federal Financial Participation (FFP) for the medically necessary services provided to eligible individuals ages 21-64 with a Substance Use Disorder (SUD), residing in facilities meeting the regulatory definition of an Institute for Mental Disease (IMD). Current Medicaid statue does not allow FFP for care or services for any individual who has not attained 65 years of age and who is a patient in an IMD. This restriction is known as Medicaid’s IMD exclusion. This 1115 waiver will provide the state flexibility in the service delivery system with the aim of expanding access to treatment modalities and bridging medical and behavioral health needs to ensure a full continuum of care for people with SUD.

Update on 1115 Waiver Submission

On November 26, 2019, MaineCare submitted a 1115 demonstration waiver application to CMS with the goal of improving the SUD service delivery system. If approved, this waiver would allow for additional federal funding for residential or inpatient SUD treatment for MaineCare-enrolled adults and would provide state flexibility to pilot four services focused on MaineCare-enrolled parents with SUD who are involved with or at-risk of involvement with Child Protective Services. The proposed pilots include community-based skill development, parenting interventions, and MaineCare eligibility changes intended to address coverage and service delivery gaps that impact the health and well-being of this target population and their families. For questions about the submitted waiver, please contact Olivia Alford at Olivia.Alford@maine.gov

Please note, the waiver application includes provisions related to SUD treatment and recovery only. Earlier this year, the Department proposed incorporating provisions related to SMI/SED residential and inpatient services as part of this submission; however in response to stakeholder feedback these two proposals have been separated. Delivery system improvements related to SMI/SED remain a priority and will be addressed after further system-wide capacity and needs assessment and informed by further stakeholder engagement.

IMD Exclusion for SUD Public Hearings

Hearing 1: Augusta Public Hearing
Date: March 6, 2019
Time: 10:00 AM
Location: 111 Sewall Street, Rm. 103A&B
  Augusta, ME 04330
Conference Line: 1-877-455-0244
Passcode: 7319892834
   
Hearing 2: Portland Public Hearing
Date: March 7, 2019
Time: 10:00 AM
Location: 151 Jetport Blvd., Rm 139A&B
  Portland, ME 04101
Conference Line: 1-877-455-0244
Passcode: 7319892834

IMD Exclusion for SUD Written Comments

Written comments on the proposed changes are welcome and will be accepted from February 22, 2019, through 11:59PM on March 25, 2019. Written comments may be submitted in the following ways:

  1. By email to: Policy.DHHS@maine.gov
  2. By mail to: Division of Policy/MaineCare Services, 242 State St. 11 State House Station, Augusta, Maine 04333-0011

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