Date posted:
Attachment(s):
Notice of Agency Waiver Renewal
AGENCY: Department of Health and Human Services (DHHS), Office of MaineCare Services
RULE TITLE OR SUBJECT: 1115 Waiver Renewal Application
WAIVER: Section 1115(a) waiver demonstration, “Maine Substance Use Disorder (SUD) Care Initiative"
CONCISE SUMMARY: The state of Maine DHHS seeks a five-year waiver renewal approval period to operate this waiver statewide, with a requested start date of January 1, 2026. The currently approved waiver authorizes the state to receive Federal Financial Participation (FFP) for services described in the Maine Medicaid state plan when provided to members residing in Institutions for Mental Diseases (IMDs) for short-term stays to receive SUD treatment. The current SUD expenditure authority expires on December 31, 2025.
DHHS seeks to extend its Section 1115(a) waiver demonstration, “Maine Substance Use Disorder (SUD) Care Initiative,” currently approved through December 31, 2025 (11-W-003381), for another five years. This waiver submission proposes implementing an updated program design that strengthens the behavioral health continuum of care, improves care transitions from institutions to the community, increases access to traditional healing services, and improves health outcomes by addressing Health-Related Social Needs (HRSN). With the expansion of intent, Maine seeks to rename this demonstration to Maine’s Whole Person Care Waiver.
General:
- Continuation of approval for eligibility for covering parent(s) who would otherwise lose MaineCare eligibility due to the change in household size when their child is removed from the home under state law.
- Continuation of approval to offer the Parenting Support Services pilot focusing on two services to support children and families: Attachment Biobehavioral Catch-up and Visit Coaching.
- Continuation of approval to offer daily living skills development, community integration, and housing support services to eligible parents with an SUD.
Proposed Additional Waiver Services:
- Maine is requesting new waiver authority under Section 1115 to claim FFP for the provision of contingency management (CM) services.
- Maine is requesting new waiver authority under the Section 1115 Serious Mental Illness (SMI) demonstration opportunity. Maine seeks expenditure authority to stabilize individuals who require care from IMDs on a short-term basis and ensure that they are supported in their transitions to the community.
- Maine is requesting expenditure authority for federal matching funds to provide a Transitions of Care Incentive Payment pilot.
- Maine is requesting waiver authority to extend Medicaid coverage for targeted Medicaid services up to 90 days pre-release for individuals transitioning from jails, prisons, and the youth correctional facility.
- Maine is requesting expenditure authority for federal matching funds to provide targeted services, including food pharmacy/fruit and vegetable prescriptions, nutrition counseling/education, case management for nutrition benefits, and medically tailored meals.
- Maine is requesting expenditure authority for federal matching funds to cover recuperative care, including room, board, and onsite clinical services. MaineCare is seeking federal matching funds for recuperative care for members experiencing homelessness and pre-procedural and post-hospitalization care for individuals with an acute medical condition. The state proposes a recuperative care pilot with three sites.
- Maine is requesting expenditure authority for federal matching funds to provide bundled and cost-based Per Member Per Month payments to certified recovery residences.
- Maine is seeking expenditure authority to support the non-federal share of funding for pre-release services for justice-involved individuals and related capacity building, and for HRSN services and related capacity building for the next demonstration period using Designated State Health Program expenditures.
- Maine requests the authority to cover traditional healing therapies received through Indian Health Services or Tribal Organizations as defined by CFR Title 42, Chapter I, Subchapter M, Part 137, Subpart B, § 137.10, for Medicaid and CHIP beneficiaries who can receive services delivered by or through these facilities. Maine is working with the Wabanaki Nations to develop and solidify the specifics of the request, including the eligible services, benefits, and provider types.
- Capacity Building Funds: To support cross-system implementation efforts for this initiative, Maine is requesting $15 million in total computable capacity-building funds. Capacity-building funds will be available to entities partnering with DHHS to implement the initiative, including correctional facilities. This funding will support planning and implementation activities, including but not limited to conducting stakeholder engagement, hiring and training new staff, strengthening health information technology systems, and establishing new operational workflows, processes, and space modifications needed to implement this initiative across participating correctional settings.
Proposed Benefit Coverage, Enrollment Limits, Eligibility Requirements, and Cost Sharing Benefit Coverage:
The State continues to request an enhanced set of benefits for the currently approved SUD Pilots. Other changes to benefits proposed in the renewal include:
- Providing Contingency Management services
- Providing targeted pre-release services for justice-involved individuals in the 90 days prior to release
- Provide access to traditional healing received through Indian Health Services, Tribal, or urban Indian organization facilities for Medicaid and Children's Health Insurance Program beneficiaries who can receive services delivered by or through these facilities
- Providing the HRSN pilots: Food is Medicine, Recuperative Care, and the Structured Recovery Housing Services
Enrollment Limits: No enrollment limits exist for people who meet the waiver participation requirements in Section II (Continuing Demonstration Features and Changes Requested to the Demonstration).
Eligibility Requirements: DHHS proposes implementing the initiatives across all “full benefit” eligibility groups. The implementation plans will provide processes to streamline the exchange of data to demonstration settings about beneficiaries’ Medicaid status. Currently, people enrolled in Medicaid and in a carceral setting have their Medicaid suspended. Process improvements to streamline Medicaid determinations will be included in the implementation plan for people not enrolled in Medicaid prior to incarceration.
Delivery System: All MaineCare members will continue to receive services through the current delivery system
Cost Sharing: No changes to cost sharing are proposed under this demonstration. Cost sharing under this demonstration is consistent with the provisions of the approved state plan.
Demonstration Enrollment, Expenditures, and Budget Neutrality: The renewal application includes budget Cost Neutrality and Derivation of Estimates for the requested extension period.
Please see the accompanying draft application for all proposed changes included in the renewal.
DHHS is accepting comments through 11:59 pm, April 22, 2025. Any interested party may obtain a copy of the waiver application. A printed copy may be obtained by calling Lisa Weaver at (207) 624-4050 or emailing lisa.weaver@maine.gov.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for the full public notice document, waiver application draft, and to submit comments.
Maine DHHS intends to host two public workshops on April 3, 2025 and April 10, 2025. For more information, the public notice and information for public workshops on this waiver are posted online at http://www.maine.gov/dhhs/oms/rules/index.shtml DHHS will also post a finalized draft waiver application online, including a summary of public comments received, once available.
Table 1. Public Hearing
|
Hearing 1: Statewide Virtual/Teleconference Hearing Date: April 3, 2025 Time: 11:30 AM Location: Virtual & Teleconference link: https://mainestate.zoom.us/j/81403447665?pwd=yXRweDjF0EblbXEW5dfillZsMurS4n.1 |
Hearing 2: Augusta Hearing Date: April 10, 2025 Time: 9:00 AM Location: 109 Capitol St, Augusta, Maine 04330 Room A&B First Floor
|
STATUTORY AUTHORITY: 42 CFR §441.304
DEADLINE FOR COMMENTS: Comments must be received by 11:59 pm, April 22, 2025
AGENCY CONTACT PERSON: Courtney Pladsen, Medical Director
AGENCY NAME: MaineCare Services
ADDRESS: 109 Capitol Street
Augusta, Maine 04333-0011
EMAIL courtney.pladsen@maine.gov
Demonstration Waivers
Office: MaineCare Services
Email: courtney.pladsen@maine.gov
Comment deadline:
On