Advancing the Nation’s HealthIn his first legislative address to the 89th Congress in January 1965, Advancing the Nation’s Health, President Lyndon Johnson makes the case to invest in removing barriers to health care for seniors, individuals with disabilities, and children and youth—setting the stage for Medicaid legislation. 
Block Grants and Enhanced Services for KidsBeginning in 1998, Maryland uses Child Health Block Grants to bolster its MCHP programs, funding enhanced services for children.  Between 1998-2003, Maryland is one of only a handful of states that spends all federal block grant funds within the three-year authorization period. As a result, Maryland receives nearly $404 million in reallocated funds from the federal government through Fiscal Year 2006.
State Children’s Health Insurance is EstablishedPresident Bill Clinton signs the Balanced Budget Act of 1997 into law in August 1997, establishing the State Children’s Health Insurance Program (SCHIP). SCHIP gives states the option to expand Medicaid coverage to children whose family incomes are at or below 200 percent of the federal poverty level. The Balanced Budget Act of 1997 also establishes a new State Plan option that grants states the right to require all eligible participants to enroll in managed care.
Maryland Medicaid’s Voluntary HMO ProgramMaryland Medicaid implements a voluntary health maintenance organization (HMO)  program for Medicaid participants in 1975. For the first nine years of Maryland’s Medicaid program, the State delivered health care services to Medicaid participants entirely through a traditional fee-for-service model. Under the new voluntary HMO program, Maryland’s six State-certified HMOs promoted preventive health care and efficient use of  health resources. In the mid- to late 1970s, Maryland Medicaid health maintenance organization enrollment averaged about 30,000 persons per year.
President Johnson Signs the Social Security Amendments of 1965Congress passes the Social Security Amendments of 1965 on March 1, 1965; President Johnson signs the bill into law on July 30.    The Social Security Amendments of 1965 establish Medicaid, which provides government-sponsored health insurance coverage for seniors, low-income children, caretaker relatives, the blind, and individuals with disabilities.
Maryland Implements Living at Home and Older Adults WaiversIn continued support for individuals to receive care in home and community-based settings, Maryland implements the Living at Home and Older Adults Waivers in 2001. The Living at Home Waiver serves individuals up to age 65 and offers personal assistance with activities of daily living and instrumental activities of daily living, as well as other services. The Older Adults Waiver provides services to individuals ages 50 and above who require assisted living and personal assistance. 
Health Care Reform: Maryland and Community First ChoiceEstablished by the Affordable Care Act, Maryland implements Community First Choice in January 2014, expanding the long-term services and supports available in the community without a waiting list. Maryland is one of the first states to implement Community First Choice.  Community First Choice implementation allows Maryland to merge the Older Adults and Living at Home Waivers while improving the personal care program. These changes streamline access to services, expand the services offered, maximize federal matching funds, improve rates, and enhance quality for people who need long-term services and supports.
Health Care Reform: Maryland and Medicaid ExpansionMaryland fully implements the Affordable Care Act’s Medicaid expansion in 2014.  Beginning January 1, 2014, Primary Adult Care participants roll into full Medicaid coverage, now eligible for cost-sharing with the federal government. Baltimore Oriole Adam Jones went to bat for health insurance, encouraging Marylanders to sign up for coverage.
Behavioral Health Integration: SUD Treatment Carve-OutTo facilitate more coordinated and effective behavioral health care, Maryland carves substance use disorder treatment out of managed care, effective January 1, 2015. The carve-out implements an integrated behavioral health service delivery and finance system for Medicaid participants by administering all specialty mental health and substance use services through a single administrative services organization: Beacon Health Options.  Today, Maryland Medicaid provides access to an array of mental health and substance use disorder treatment services for more than 100,000 Marylanders.
OBRA ‘81: Freedom of Choice and HCBS WaiversThe Omnibus Budget Reconciliation Act of 1981 (OBRA ‘81) establishes both Freedom of Choice and Home and Community-Based Services waivers for Medicaid. Under these waivers, State Medicaid programs can test new care delivery options for certain individuals receiving long-term services and supports. The Freedom of Choice Waiver (1915b) allows states to implement a managed care delivery system that restricts the types of providers that people can use to get Medicaid benefits. The Home and Community-Based Services Waiver (1915c) enables states to cover services targeted to support individuals in the community as an alternative to care in a nursing home or other institution.
Governor Hogan Supports CHIP ReauthorizationIn March 2015, Governor Larry Hogan writes two letters in support of two major pieces of Medicaid legislation. Governor Hogan’s first letter is in support of CHIP reauthorization funding, noting the significant fiscal impact on Maryland if the funds are not reauthorized. Maryland’s ability to maintain expansive eligibility standards is contingent upon the federal government’s enhanced reimbursement for CHIP participants.
Maryland Implements MedicaidMaryland was the first state to adopt a medical care program administered outside of a welfare agency.  For nearly 20 years prior to Medicaid’s passage, Maryland’s State-funded medical assistance program helped Marylanders in need gain access to health care.  As the scope and range of the State plan was similar to the federal plan that Congress adopted in 1966, Maryland replaced the State medical care plan to implement Medicaid on July 1, 1966. On average, in 1966, Maryland Medicaid provided coverage for over 113,000 Marylanders. Today, 1.2 million Marylanders are covered under Medicaid.
Maryland Offers Personal Care and Medical Day CareMaryland Medicaid begins offering two new programs in 1981, both designed to help disabled and elderly individuals at risk of institutionalization in a nursing home.  The Medical Assistance Personal Care Program provides in-home assistance with activities of daily living. Medical day care services include skilled nursing, medication monitoring, and nutritional services, in addition to personal care. During Fiscal Year 1981, Maryland Medicaid medical day care providers rendered care to 158 participants. Today, the Medical Day Care Services Waiver serves 4,919 Marylanders.
Maryland Medicaid and You
Celebrating 50 Years of Impact
TEFRA ‘82: Cost-Sharing and ‘Katie Beckett’ CoveragePresident Ronald Reagan signs the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA ‘82) into law in September 1982. Among TEFRA ‘82’s provisions is the ability to allow States to impose nominal cost-sharing on certain Medicaid participant groups or services. TEFRA ‘82 also permits States to expand Medicaid coverage to “Katie Beckett” children—or, certain children under 18 whose disabilities require institutional levels of care, but want to receive care at home.
Maryland Implements its First HCBS WaiverMaryland implements its first home and community-based services waiver, known as the Community Pathways Waiver, for individuals with developmental disabilities in 1984. By the end of the third year of the Community Pathways Waiver Program, approximately 700 individuals were served in less restrictive community settings statewide. Today, this waiver serves over 14,500 individuals in Maryland.
President Reagan signs MMPPPATo strengthen participant protection and bolster anti-fraud efforts, President Ronald Reagan signs the Medicare and Medicaid Patient and Program Protection Act of 1987 into law.  An amendment to the “Anti-Kickback Statute,” the legislation aims to protect Medicaid participants from unfit health care practitioners, and to generally strengthen Medicaid anti-fraud provisions.
Maryland’s Waiver for Children with Autism Spectrum DisorderMaryland Medicaid also adopts the Waiver for Children with Autism Spectrum Disorder in 2001. Through the Waiver for Children with Autism Spectrum Disorder, local school systems provide or arrange for case management services, called service coordination. Local lead agencies and school systems also help individuals access the many community services offered through this waiver. Today, the Waiver for Children with Autism Spectrum Disorder serves more than 1,000 children with autism in Maryland.
Maryland Implements the Model WaiverMaryland Medicaid implements the Model Waiver for Medically Fragile Children in 1985. The Model Waiver covers “Katie Beckett”children. When Maryland Medicaid first implemented the Model Waiver, only 50 chronically disabled children were eligible to receive services. Today, Maryland’s Model Waiver allows 200 children with complex health care needs to  receive medical care at home, as opposed to in a hospital, nursing facility, or any other long-term care facility.
Maryland Implements the New Directions WaiverMaryland implements a new Independent Plus self-directed home and community-based services waiver known as New Directions for individuals with developmental disabilities in 2005. Self-directed means that participants are able to make decisions about certain aspects of their services, such as who provides the services, when the services are provided, and how much staff are paid. Today, over 500 individuals self-direct their services and budgets.
Maryland’s Primary Adult Care Program BeginsMaryland institutes the Primary Adult Care (PAC) Program beginning July 1, 2006, offering primary care and pharmacy services to Maryland Pharmacy Assistance participants and other individuals earning less than 116 percent of the federal poverty level. Primary Adult Care participants enroll to receive services from a HealthChoice managed care organization, with the exception of specialty mental health services offered on a fee-for-service basis.  Upon implementation, PAC serves 25,000 participants.
OBRA ‘87: More Coverage for Pregnant Women and ChildrenThe Omnibus Budget Reconciliation Act of 1987  (OBRA ‘87) extends the option to allow states to expand Medicaid coverage to pregnant women and infant children whose household income is at or below 185 percent of the federal poverty level. OBRA ‘87 also institutes new care quality standards, new monitoring policies, and new enforcement procedures for Medicaid-certified nursing homes.
Serving More Kids in Maryland: MCHP PremiumMaryland implements MCHP Premium as a separate SCHIP program in 2001, extending Medicaid benefits to children in families with incomes between 200 and 300 percent of the federal poverty level. Families with children enrolled in MCHP Premium pay a small monthly premium for the same Medicaid benefits for kids. In addition to serving more kids, Medicaid eligibility is extended for pregnant women from 185 percent of the federal poverty level to 250 percent of the federal poverty level.  Today, there are approximately 30,000 Maryland children participating in MCHP Premium.
Introducing EPSDTTo ensure availability of treatment for conditions affecting growth and development, the federal government creates the Early and Periodic Screening, Diagnosis, and Treatment Program, known as EPSDT, in January 1967.  For Medicaid participants under 21 years of age, EPSDT provides prevention and early intervention screening, as well as dental, hearing, and vision services.  Healthy Kids is Maryland’s EPSDT program.
Governor Hogan  Supports SUD Treatment in IMDsGovernor Hogan’s other letter of support concerns Medicaid reimbursement for substance use disorder treatment, particularly as related to federal rules surrounding the exclusion of institutions for mental diseases as Medicaid-reimbursable substance use disorder treatment providers. Given growing demand for and contemporary understanding of substance use disorder treatment, Governor Hogan’s letter expresses support for legislation to extend reimbursement to institutions for mental disease, in effort to alleviate a provider shortage in treating substance use disorders.
Deficit Reduction Act of 2005: Money Follows the PersonThe Money Follows the Person Rebalancing Demonstration supports states in reforming their systems of long-term services and supports in an effort to reduce institutional care while developing community-based resources. Enacted by the Deficit Reduction Act of 2005 and extended by the Affordable Care Act in 2010, Money Follows the Person enables older adults and people with disabilities to fully participate in their communities and live in the setting of their choice. The goals of the Money Follows the Person demonstration are to increase the use of home and community-based services, reduce the use of institutional services, eliminate barriers to community living, strengthen the ability of Medicaid programs to transition people out of institutions, and to improve the quality of community services.
Maryland Implements the Maryland Access to Care ProgramMaryland Medicaid implements the Maryland Access to Care Program in 1992. The Maryland Access to Care Program connects Medicaid participants  who aren’t enrolled in an HMO to primary care medical providers.  The primary care medical provider both ensures participant access to necessary services and helps control unnecessary service utilization. Children are connected to EPSDT providers.  Within the first 18 months of the Maryland Access to Care Program, approximately 220,000 eligibile participants had primary care providers.
OBRA ‘90: “Best Price” Pharmaceutical Rebates for MedicaidThe Omnibus Budget Reconciliation Act of 1990 (OBRA ‘90) requires states to expand phased-in Medicaid coverage to children ages six to 18, whose household income is at or below 100 percent of the federal poverty level. OBRA ‘90  also creates the Medicaid prescription drug rebate program, requiring pharmaceutical manufacturers to offer states and the federal government “best price” rebates. In Fiscal Year 1990, Maryland Medicaid dispensed 3.7 million prescriptions, at an average cost of $19.13 per prescription.
OBRA ‘86: Coverage Expansions for Pregnant Women and InfantsThe Omnibus Budget Reconciliation Act of 1986  (OBRA ‘86) extends the option to allow states to expand Medicaid coverage to pregnant women and infants whose household income is at or below 100 percent of the designated federal poverty level. OBRA ‘86 also requires states to provide Medicaid coverage of emergency medical treatment for individuals whose immigration status is the lone disqualifier for Medicaid eligibility.
CHIP ReauthorizationPresident Barack Obama signs the Children’s Health Insurance Reauthorization Act (CHIPRA) of 2009 into law on February 1, 2009. CHIPRA enhances funding for CHIP coverage, enabling CHIP programs across the nation to provide health insurance for an additional 4.1 million children.
Pregnant Women & Children’s ProgramThe Pregnant Women and Infants Program expands to become the Pregnant Women and Children’s Program in 1988. Within a year, the Program adopts the option to expand Medicaid eligibility to pregnant women whose income is at or below 185 percent of the federal poverty level. The Program also covers children ages one to six, born after September 30, 1983, whose family income is at or below 100 percent of the federal poverty level. Enabling federal legislation also allows Maryland to expand the range of services available to pregnant women through the Maryland Healthy Start Program. In its first year, the Pregnant Women and Children’s Program provided presumptive eligibility ambulatory care to 7,906 women, full Medicaid to 6,160 women, and full Medicaid to 2,790 kids.
PAC Expansion: MA4FamiliesMaryland extended full Medicaid eligibility to parents and caretaker relatives of children enrolled in Medicaid or MCHP with household incomes below 116 percent of the federal poverty level in July 2008. Known as MA4Families, enrollment in this expansion increased from 7,832 participants to nearly 101,000 participants by December 2012. Baltimore Ravens Safety Ed Reed helped Maryland Medicaid tackle uninsured rates throughout the State by encouraging enrollment in MA4Families.
Beyond 50: Next Year and BeyondForging ahead to our 51st year, Maryland Medicaid is embracing opportunities to design and implement new care delivery models to improve access and quality of care for individuals with complex health care needs. We will continue to implement additional measures to enhance our participants’ health and quality of life, all with an eye toward delivering value-based care in Maryland. For the next 50 years and beyond: program by program, person by person, Maryland Medicaid will continue to make an impact.
Maryland’s Pregnant Women and Infants ProgramMaryland Medicaid begins a journey to de-link Medicaid from welfare benefits for women and children, first by implementing the Pregnant Women and Infants Program in 1987. The Pregnant Women and Infants Program expands Medicaid eligibility to pregnant women whose income is at or below 100 percent of the federal poverty level and infants up to one year of age. The Program provides full Medicaid benefits during pregnancy and 60 days postpartum; infants receive full Medicaid benefits, as well.
The Affordable Care Act is Signed Into LawOn March 23, 2010, President Barack Obama signs the Patient Protection and Affordable Care Act, or the Affordable Care Act (ACA), into law. The legislation marks the most ambitious reform to health care delivery in the nation’s history. Among historical reforms are health insurance coverage for nearly all eligible adults up to 138 percent of the federal poverty level, with enhanced federal match for services rendered to new Medicaid participants.
Maryland Implements the Brain Injury WaiverFor individuals ages 22 - 64, Maryland implements the Brain Injury Waiver in 2003 to provide services in the community to certain individuals from state psychiatric hospitals, state-owned and operated facilities, chronic hospitals that are accredited for brain injury rehabilitation, or for whom Maryland pays an out-of-state facility. Services include case management, individual support services, supported employment, and all standard Medicaid benefits. Today, the Brain Injury Waiver serves 87 Marylanders.
Maryland Submits the HealthChoice Waiver RenewalMaryland submits a renewal request for Medicaid’s HealthChoice waiver, for a period of three years, in July 2016. The renewal request is focused on cost-effective services that target significant, complex health care needs. Under the request to renew, Maryland Medicaid seeks to strengthen its HealthChoice program by expanding services in residential treatment for substance use disorders; piloting community health programs for high-risk pregnant women and criminal justice-involved individuals; and offering increased community services. Maryland is also seeking a waiver to authorize Medicaid to provide dental care up to age 26 for former foster care youth.
Maryland’s Electronic Health Records Incentive ProgramTo modernize care delivery and help reduce costs, Maryland Medicaid implements the Electronic Health Records (EHR) Incentive Program in 2011.    Participation in the EHR Incentive Program means more providers receive financial incentives for modernizing how they deliver care. An estimated 81 percent of eligible Medicaid providers have participated in the EHR Incentive Program for at least one year.  To date, Maryland has paid over $167 million to Medicaid providers and hospitals for acquiring and using electronic health records.
Maryland Implements the 1915(i) State Plan Amendment To enhance services to children and youth with serious emotional disorders and their families, Maryland implements the 1915(i) State Plan Amendment in 2016. Services are designed to support the participant remaining in their homes by providing a wrap-around service delivery model. In addition to the full range of Medicaid somatic and behavioral health benefits, services covered include family peer support, intensive in-home services, mobile crisis and stabilization, respite services, expressive and experiential behavioral services, and customized goods and services. 
Streamlined Eligibility: Pregnant Women and ChildrenIn 1997, Maryland Medicaid streamlines the eligibility process for pregnant women and children.  For the first time, Medicaid funds eligibility workers at local health departments and requires them to perform expedited Medicaid eligibility determinations for pregnant women and children within a ten-day time limit. After ten years in operation, the Pregnant Women and Children’s Program served approximately 10,000 women per month and 73,000 kids during the year.
Maryland Receives Balancing Incentive Program FundsMaryland becomes one of the first states to receive Balancing Incentive Program, or BIP, funding in 2012.  Established by the Affordable Care Act, BIP allocates more than $3 billion to aid states in making the significant structural changes required to facilitate the shift from institutional settings to home and community-based care settings. In Maryland, BIP funding is used, along with funding from the Money Follows the Person demonstration, to expand and enhance the Maryland Access Point sites across the State, in order to improve information and access for Marylanders seeking long term services and supports. Maryland is one of only 18 states participating in the Balancing Incentive Program.
Maryland Implements the Diabetes Care ProgramMaryland Medicaid implements Diabetes Care Program in 1991. To be eligible, participants have to have been hospitalized for a diabetes-related condition. Participants receive diabetes education, nutritional counseling, home glucose monitoring, and prescription footwear. The Diabetes Care Program embarked on an aggressive enrollment campaign in its first year, resulting in 1,978 participants and 388 providers.
OBRA ‘89: EPSDT Expansion and Coverage for FQHCsThe Omnibus Budget Reconciliation Act of 1989 (OBRA ‘89) requires states to expand Medicaid coverage to pregnant women and children up to age six whose household income is at or below 133 percent of the federal poverty level. OBRA ‘89 also expands EPSDT benefits to include to all diagnostic and treatment services allowed under Medicaid to be covered in all states. OBRA ‘89 further expands Medicaid coverage by requiring states to cover services rendered at federally-qualified health centers (FQHCs).
Maryland Implements the Senior Assisted Housing WaiverMaryland Medicaid implements the Senior Assisted Housing Waiver in 1993. The Senior Assisted Housing Waiver targets individuals aged 62 and over and offers assisted living services, environmental assessments and modifications, behavioral consultation, and Senior Center Plus services. In its first year, the Senior Assisted Housing Waiver, administered by the Maryland Department of Aging, served only four participants. Within four years, it served 52 participants.
PAC Expansion: Substance Use Disorder TreatmentIn January 2010, Maryland Medicaid both extends limited substance use disorder treatment to the PAC program and increases reimbursement rates for Medicaid-funded substance use disorder (SUD) treatment services. Rate increases for substance use disorder treatment, individual and group counseling, intensive outpatient services, and methadone maintenance programs accompanied the PAC SUD treatment expansion.
Money Follows the Person in MarylandFollowing 2007 approval to participate in the program, Maryland begins transitioning participants into the Money Follows the Person demonstration project in 2008. Effort under Money Follows the Person includes peer mentoring, enhanced transition assistance, improved information technology, housing assistance, and flexible transition funds. Since 2008, Money Follows the Person has helped over 2,567 nursing home residents return to the community. 
Maryland Launches the Family Planning ProgramTo help more low-income women have access to critical women’s health services, Maryland Medicaid implements the Family Planning Program in 1994.  The Family Planning Program offers limited benefits to women who deliver while enrolled in Medicaid. Eligible women may retain Family Planning coverage for five years following Medicaid eligibility due to pregnancy.  By the end of Fiscal Year 1995, approximately 7,400 women were enrolled in the Family Planning Program.
Chronic Health Homes in MarylandIn effort to improve health outcomes for individuals with chronic conditions by providing enhanced care management and care coordination, Maryland Medicaid implements Chronic Health Homes in October 2013. Maryland’s Chronic Health Home program targets Medicaid participants with serious and persistent mental illness; an opioid substance use disorder and risk of additional chronic conditions due to tobacco, alcohol, or other non-opioid substance use; or children with serious emotional disturbances. Since the inception of Chronic Health Homes in Maryland, 6,000 participants have received services.
ARRA: Increased Match and Health IT FundingPresident Barack Obama also signs the American Recovery and Reinvestment Act (ARRA) of 2009 into law in February 2009. ARRA carries $149 billion in new health spending to states. As the economic recession pushes more families into Medicaid-eligible incomes, ARRA provides a temporary increase in federal match for Medicaid.  Other ARRA provisions include funding for health information technology.
Maryland Kids Count ProgramTo help bridge some of the Medicaid coverage gaps affecting Maryland’s youth, Maryland Medicaid implements the Kids Count Program in October 1993. Maryland Kids Count covers children over one year of age who were born after September 30, 1983 and above the 100 percent federal poverty level income threshold that the Pregnant Women and Children’s Program covers, but less than 185 percent of the federal poverty level. 2,400 children in Maryland became eligible for preventive and primary care services when Maryland Medicaid implemented Maryland Kids Count.
Maryland Expands the Family Planning ProgramWomen no longer need to be postpartum to be eligible for Maryland Medicaid’s limited Family Planning Program coverage after the Program expands in 2012.  Women whose income is at or below 200 percent of the federal poverty level, are under 51 years old, and who meet citizenship requirements are eligible. Benefits extend beyond contraceptives to physical exams and screenings. There are also no longer time limits for enrollment; women may reapply for Family Planning coverage every year and postpartum women continue to be automatically enrolled for 12 months. 
Maryland is Recognized for Excellent Dental Services for KidsFollowing the tragic death of a child due to a dental abscess in 2007, Maryland formed a Dental Action Coalition and moved rapidly to improve dental care for children. Prompt action worked. In 2011, Maryland Medicaid was recognized by the PEW Center on States as the nation’s top performer in providing dental services to children.
Maryland Children’s Health Program: MCHPMaryland Medicaid launches the Maryland Children’s Health Program (MCHP) in July 1998, offering full benefits for certain children through the HealthChoice program. Uninsured kids up to age 19, who are not eligible for Medicaid, but whose household income is at or below 200 percent of the federal poverty level, are eligible to enroll. Prior to OBRA and SCHIP expansions for pregnant women and children, only approximately 165,000 Maryland children were enrolled in Medicaid. Today, over 600,000 children in Maryland are enrolled in Medicaid or MCHP.
PACE: Program of All-Inclusive Care for the ElderlyTo provide comprehensive medical and social services needs for older adults, Maryland implements the Program of All-Inclusive Care for the Elderly, or PACE, in 1996. For participants 55 and older, PACE is designed to provide and coordinate all necessary preventive, primary, acute, and long-term care services so older adults can continue to live in the community.  PACE services are offered through Hopkins ElderPlus, located on the campus of Johns Hopkins Bayview Medical Center in Baltimore. Today, Maryland Medicaid’s PACE Program serves over 100 Marylanders.
Olmstead v. L.C.The Supreme Court’s landmark ruling in Olmstead v. L.C. finds that the Americans With Disabilities Act can require states to provide community-based services for disabled individuals, if institutionalization is otherwise unjustified. As a result, Medicaid plays an enhanced role both in advancing community integration for individuals with disabilities, and in diminishing disability-based discrimination.
In-Home Supports Assurance: ISAS in Maryland HomesTo aid in home and community-based service transition, Maryland Medicaid implemented the LTSSMaryland Tracking System and the In-Home Supports Assurance System (ISAS) in 2013. Using real-time information, the LTSSMaryland Tracking System connects supports planners with participant information. The tracking system also incorporates information generated by ISAS’s in-home services verification system, which enhances provider accountability when billing for in-home services. To date, a real-time tracking system for in-home services has saved Maryland taxpayers $18.9 million.
Mandatory Managed Care: Introducing HealthChoiceAfter 1996 federal approval, Maryland launches HealthChoice—a new Medicaid mandatory managed care program—on July 1, 1997.  HealthChoice features inclusive eligibility, statewide mandatory enrollment, risk-based purchasing, capitated rates, and service carve-outs, including mental health services. At launch, roughly 80 percent of all Maryland Medicaid participants are enrolled in HealthChoice.
Nursing Home Pay-for-PerformanceIn 2010, Maryland implements the Nursing Home Pay-for-Performance Program, in order to recognize and reward quality of care, and to provide incentives for quality improvement.  Performance indicators include staffing levels and staff stability in nursing facilities, family satisfaction survey, quality outcomes, and infection control measures. Today, over $5.6 million is distributed annually among both the highest-performing nursing facilities, and those that have shown year-to-year improvement in performance measures.
Health Care Reform: Streamlined Eligibility DeterminationThrough Maryland Health Connection, most Medicaid applicants are able to apply for Medicaid coverage and receive real-time eligibility determinations. A full array of consumer assistance options, including on-line, telephonic, mail, and in-person options, accompany the newly streamlined eligibility determination process. Expanding access to Medicaid coverage under the ACA helped reduce the percent of uninsured in Maryland from 12 percent to six percent, expanding coverage to about 270,000 adults by July 2016.
President Nixon Signs the Social Security Amendments of 1972President Nixon signs the Social Security Amendments of 1972 on October 30, 1972.    Major provisions of the Social Security Amendments of 1972 establish the Supplemental Security Income (SSI) program, which provides cash assistance for seniors and individuals with disabilities. Medicaid eligibility for seniors and individuals with disabilities may also be linked with SSI. Today, Maryland Medicaid covers 125,000 people under the SSI benefit.
Behavioral Health IntegrationAs mental health and substance use conditions often co-occur, Maryland Medicaid begins to integrate mental health and substance use disorder treatment systems through an initiative known as  Behavioral Health Integration in 2012. Maryland Medicaid begins the process of pursuing a carve-out of both mental health and substance use disorder treatment funding, with incentives across the system for more coordinated and more effective care. As a result of Behavioral Health Integration, Maryland currently operates a system that has a single point of entry for both participants and providers.