Notice of MaineCare 1115 Waiver Application: Substance Use Disorder Care Initiative Amendment

Notice of MaineCare 1115 Waiver Application: Substance Use Disorder Care Initiative Amendment

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

NATURE OF PROPOSED CHANGES: The state is requesting a budget neutrality projection adjustment for two components of the current 1115 Waiver Substance Use Disorder (SUD) Care Initiative.

The first is related to reimbursement for clinically appropriate services that are otherwise approved under the Maine Medicaid State Plan, delivered to individuals aged 21-65 with Substance Use Disorder (SUD) by Institutions of Mental Disease (IMDs). The State did not have historical data to base the projection of costs associated with coverage for the Expansion Adults population when developing the original budget neutrality costs; in addition, continuous coverage requirements in place during the Public Health Emergency greatly increased enrollment of the expansion population. As a result, annual utilization for this population is much higher than in Calendar Year 2019.

The second is related to Pilot 1 Extended MaineCare Coverage. Individuals eligible for this pilot are MaineCare eligible parents who would otherwise lose eligibility due to the change in household size when their child is removed from the home pursuant to state law. The initial Per Member Per Month (PMPM) estimate for this project was based on Calendar Year 2021 actuals. While expenditures were below limits in Years 1-3, subsequent rate increases and higher than anticipated utilization requires an amendment to these Without Waiver PMPM values.

REASON FOR PROPOSED CHANGES: The Department is requesting an adjustment to the budget neutrality of the current 1115 Waiver SUD Care Initiative Demonstration to address the budget neutrality overages the State has experienced in Year 2 and Year 3 of the demonstration.

ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: DHHS understands that the potential expenditures incurred pursuant to the waiver of expenditure authority are considered “hypothetical expenditures.” For these hypothetical expenditures, CMS adjusts the budget neutrality test to effectively treat these expenditures as if they were approved Medicaid State Plan services and therefore these expenditures do not necessitate savings to offset their costs.

The tables below provide historical data and projects for total expenditures and annual enrollment for the five proposed Demonstration Years (DY) (beginning with DY 1 which is equivalent to SFY 20).