[{"_1":2,"_112":-5,"_113":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6681748,"mediaKeyId","2381947-ac60c5465a5cfd6f662990455cdee51e","parentId",2381947,"title","DLS and MDH warn enrollment forecasts are volatile; audit raises questions about application processing","audioSeconds",1218,"startMs",352000,"endMs",1570000,"viewUrl","/Search/View?dp=1&key=2381947-ac60c5465a5cfd6f662990455cdee51e&start=352&end=1570","thumbnailUrl","https://assets.pipeline.soar.com/2381947-ac60c5465a5cfd6f662990455cdee51e/thumbnail_352000.jpg","articleUrl","/articles/6681748/Maryland/DLS-and-MDH-warn-enrollment-forecasts-are-volatile-audit-raises-questions-about-application-processing","mediaUrl","https://secure.pipeline.soar.com/6681748-2f238fee767d69ee2186b435763cdb61/orig.mp4?Expires=1771186218&Signature=T6b~vLxpl-1n-60AbyN2aj9lJt9AgQHEV5ZcMwqGf-jpoNzPXdAwk~MjKQXo1yI5z~tT-CJOAj9SsVRls~GKgKXZGG3OEIpwZHoWDjoo54AbMUvabZ-XpRnkxvbwMeyEu1NroqdKVx9azrcALnOv2-~g6jd9XpLf~dHck2o7JCfknJACKv6zAD08m-3~k-WhNc4VOcFMgjgQJNlvvEdt-QiER8lOVv-zRfCY7pp8QOreOLak~U78Ms7KTpWhlKwQzM3TIp8Pf2dlUMzc4F-uBfvcNnW8ThE~SD3t3oCxNgMIe0lMIlH85HNEDZdvkLFIf2tNNpzJizooaz5oPE~7TQ__&Key-Pair-Id=KUT5TJCACFTXG","author","Maryland General Assembly - Appropriations","date","2025-02-24T20:47:07.527Z","article","The committee heard extended discussion about enrollment trends, the Medicaid redetermination process and federal uncertainty.

DLS analyst Anne Braun said Medicaid and MCHIP enrollment peaked at about 1,750,000 average participants in fiscal 2023 and had declined modestly in fiscal 24 and 25 amid the unwinding of pandemic-era protections. Braun said recent system errors and federal COVID-era renewal flexibilities paused some procedural disenrollments, and an audit of the Maryland Health Benefit Exchange (OLA) found that the exchange did not always request supporting documentation for applicants who attested to having no income; state wage records suggested some of those applicants reported incomes above Medicaid thresholds. DLS asked MDH and the exchange to describe corrective actions and whether ineligible applicants were disenrolled.

MDH Director Ryan Moran said the department and the exchange have identified differing enrollment and acuity dynamics and that DLS’s forecasts did not incorporate potential federal policy shifts because of high uncertainty. Moran warned that proposals in Congress to change the federal matching rate for the ACA expansion group, impose work requirements or shift Medicaid to a block grant or per-capita cap could dramatically raise state costs or reduce federal funding, although he noted the specific fiscal effects depend on the design of any federal proposal.

Why it matters: Enrollment assumptions drive Medicaid appropriations; errors in eligibility processing or unanticipated federal changes can shift millions of dollars in state costs and affect coverage for hundreds of thousands of residents.

DLS recommended reducing FY26 funding by $132,000,000 across Medicaid and MCHIP based on its enrollment forecast; MDH disputed lowering the FY26 enrollment baseline because of ongoing data volatility and recent increases in clinical acuity among remaining enrollees. Both agencies said they would continue to share monthly data and brief the committee. The committee also asked MDH to report back on corrective actions taken in response to the exchange audit and to reconcile disenrollments across systems.","mediaType","Video","parentTitle","HHR Committee Session, 2/24/2025 #1","oneSentenceSummary","DLS and MDH told the subcommittee that recent system errors, pandemic-era renewal flexibilities and possible federal policy changes make Medicaid enrollment forecasts volatile and materially important to the FY26 budget.","taxTitle","Health and Social Services Subcommittee, Appropriations Committee, HOUSE OF REPRESENTATIVES, Committees, Legislative, Maryland","taxId",78564,"location","Maryland","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6681754,"Providers warn cuts to E&M, home- and community-based services would worsen workforce crisis",735,6557000,7292000,"/Search/View?dp=1&key=2381947-ac60c5465a5cfd6f662990455cdee51e&start=6557&end=7292","https://assets.pipeline.soar.com/2381947-ac60c5465a5cfd6f662990455cdee51e/thumbnail_6557000.jpg","/articles/6681754/Maryland/Providers-warn-cuts-to-EM-home-and-community-based-services-would-worsen-workforce-crisis","https://secure.pipeline.soar.com/6681754-e76c8cb23ecfb94f6754f62688372d9d/orig.mp4?Expires=1771186218&Signature=MDansLCZjJHeEHNm08BQSNJsVx4okl5qR7UgyD-yHNeM~~Cx--KqScA4VdmIit2odKFwFVndDZAWrcEVrzcJ7ExAgXBxgW9Ps9qLtlvpoLBgEEDnoSctuA0FTGfHUmzckrVkMvkHJp0FM4LS1tMwKWSevDwncoVoW76nq6AwAPU1ocDuCVExRSDVppOhtNQkHYSiwDk-AYbfyC~toVosC~vMm18aE8jsPzz8cvzF6xYNNV1zYQUBasNlFZ4vC0XXi-rij9U8QMJg0q3W66UAglRYm0bo957F4HbpyZK-f-a1RmRsfEW6WuUX0pQuNgkle5PjZC13Nb6sHMey0RfMjQ__&Key-Pair-Id=KUT5TJCACFTXG","Multiple provider associations and community advocates urged the Health and Social Services Subcommittee to reject analysis recommendations that would reduce provider rates included in the governor’s FY26 Medicaid allowance.

Drew Vedder of MedChi and the Maryland Academy of Family Physicians said maintaining evaluation-and-management (E&M) reimbursement above Medicare matters to keep primary care participation for Medicaid patients in support of the state’s AHEAD primary-care reforms. Anne Braun had noted DLS recommends reducing a $12,200,000 E&M enhancement in FY26; health‑system witnesses told the committee that cutting E&M rates would reduce provider participation and access for Medicaid patients.

Behavioral-health representatives stressed that a seemingly modest 1% reduction is consequential. Nicole Greiner of the Community Behavioral Health Association said, “Pay is the number 1 factor in addressing this crisis,” and warned that further cuts would accelerate staff losses and program closures when the sector already faces severe shortages.

Home- and community-based services advocates including Teresa Titus Howard of The Coordinating Center and Dana Kaufman said DLS’s recommended 2% cut to HCBS provider rates risks forcing providers to reduce staff, expand caseloads and push more people into institutional care. Kaufman told the panel that past underfunding and pandemic impacts mean the sector remains fragile and that rate reductions would likely increase state costs if clients shift to higher-cost settings such as hospitals or nursing homes.

Why it matters: Provider rate changes directly influence whether Medicaid recipients can find care in the community. Witnesses said rate reductions could increase emergency room visits, hamper the state’s ability to move people from institutions to home- and community-based care, and impede AHEAD primary-care goals.

MDH’s Ryan Moran pushed back on some DLS recommendations to cut provider increases, saying last year physicians were the only Medicaid provider group to face a cut while other sectors received increases; the FY26 enhancement restores E&M to “over 100% of Medicare” to reverse that reduction. Moran emphasized the department’s concern that reducing rates now could threaten network adequacy.

Public testimony at the hearing and multiple committee questions underscored the workforce problem and urged the General Assembly to prioritize funding rather than preemptively cutting programs that advocates said already show measurable benefits.","Health providers and advocates told the subcommittee that recommended reductions to physician E&M reimbursements, a 1% provider rate rollback and a 2% reduction to home- and community-based services would risk access and worsen a strained behavioral-health and LTSS workforce.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6681757,"DLS backs MDH scrutiny of MCO HEDIS declines; MDH adds health-equity accreditation and new incentives",72,398000,470000,"/Search/View?dp=1&key=2381947-ac60c5465a5cfd6f662990455cdee51e&start=398&end=470","https://assets.pipeline.soar.com/2381947-ac60c5465a5cfd6f662990455cdee51e/thumbnail_398000.jpg","/articles/6681757/Maryland/DLS-backs-MDH-scrutiny-of-MCO-HEDIS-declines-MDH-adds-health-equity-accreditation-and-new-incentives","https://secure.pipeline.soar.com/6681757-231fa7eca376446839f7bbb4d605a9e2/orig.mp4?Expires=1771186218&Signature=HgTlFEFkBaWNvt3~6PpeL~U4NaLwZJmLMDKCuJmReoU11KdZ-rW1taY8BUwmTi88IXO2ZQppEnk8qHRXWQ~MckR~qCLaMyJvqTgxKP1zXhKxKRI9IClHQBat8~cCXPI6yBTuVsRVMj8Cb0LeQQt29P2F0KlG0iypffjgY9XWEUIvdO4BdbDJgZeiOelrUAXcVuZxedRNYPEVtnw85OA9c0ww6hvpYkXmGXd9Oq9o3FEMtzUowLBaXrJ~eU0VW7tLCQzoElxCkBtrmiWPIgVzC7tcgoug3DgGXBvi1tDB2DvDJPX~01SrNpVkSDcxy7noixak07-nzYEn1Qw2suuoUw__&Key-Pair-Id=KUT5TJCACFTXG","The Department of Legislative Services told the Health and Social Services Subcommittee that Maryland’s managed care organizations (MCOs) reported declines on many HEDIS quality measures in calendar 2023 and that more than half of HealthChoice enrollees were in the four lowest-performing plans. DLS asked MDH to explain the decline and to describe how it will determine whether HEDIS problems merit penalties or other corrective action.

Anne Braun summarized DLS’s review of the Population Health Incentive Program (PHIP), which allows MCOs to earn a percentage of their capitated rates for meeting performance benchmarks. Braun said exhibit data show about $19,000,000 in total incentives were paid in calendar 2023, with payments ranging from about $350,000 to $5,000,000 across plans; roughly $17,200,000 had been earmarked but remained unallocated until MDH used $8,000,000 for a health equity incentive.

MDH’s Medicaid Director, Ryan Moran, told the committee the 2025 MCO contracts require health-equity accreditation and that five MCOs — Aetna, CareFirst, Kaiser, UnitedHealthcare and WellPoint — have already achieved it while the remainder have midyear check-ins and a target to complete accreditation by the end of 2025. Moran said MDH expects future population health measures to align with the AHEAD primary-care work and that the department will continue to refine accountability and sanctions policies in MCO contracts.

Why it matters: MCO performance and incentive design affect quality of care for more than 1.5 million enrollees and influence how state funds are allocated to improve health outcomes and equity.

DLS recommended reducing $9,200,000 in unallocated calendar-2023 incentive funds and lowering future incentive funding given fiscal pressures; MDH disagreed with some reductions, arguing that existing contracts and planned accountability measures mean the state should retain funds to reward and enforce improvement. Moran said MDH expects about $25,000,000 will be needed to carry out planned incentive payments and proposed a smaller cut in coordination with DBM through the supplemental process.

MDH also said it will consider whether the health-equity incentive methodology should align with the Governor’s “Enough” neighborhood-level targeting program but noted operational constraints because capitation rate setting currently operates at the county level.

Public testimony and committee questions emphasized concern about declining quality metrics and the need to preserve incentives that drive MCO improvements and support provider networks.","DLS highlighted a decline in MCO HEDIS performance and recommended reducing some unallocated incentive funds; MDH said it will require health-equity accreditation for MCOs in 2025 and expects alignment of future incentives with the AHEAD primary care model.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6681759,"DLS: Maryland Medicaid FY26 allowance $13.3B; recommends targeted reductions amid federal uncertainty",1420,315000,1735000,"/Search/View?dp=1&key=2381947-ac60c5465a5cfd6f662990455cdee51e&start=315&end=1735","https://assets.pipeline.soar.com/2381947-ac60c5465a5cfd6f662990455cdee51e/thumbnail_315000.jpg","/articles/6681759/Maryland/DLS-Maryland-Medicaid-FY26-allowance-133B-recommends-targeted-reductions-amid-federal-uncertainty","https://secure.pipeline.soar.com/6681759-5f530a6c5def2b8b74866082823a4e6e/orig.mp4?Expires=1771186218&Signature=dqn56sg~Lq6Ylcuw-DBO6NCdd8D2C-sI4LXfRF5FKg4ybKfQoFnJ8~WV~B~YrnAfKBU1heSBuhHjEq5OreJz9O4lfiyO5kYcYJDG7hMCryRQoFmQy~uABz6rBoUIl7C-n2Vn2TsvGFHHRxYqgaP9~Zau2HI4H2czgW5bYPSzDy1OemenjPeVNSL1xGBXkImCgPkod95gwT~V9y5F5fEMRyvkbb9ctHxX3zcnWgPT1KCoi1lPTzSqwUyDz48gfcPt3e5Bd43HPsPtxz3gKo5JFw3acBiZJQJPfET~FLs4d2rKGthDgtfAzxXN6jxyYNnOrYaZH9hg~OLNnihExxLtjQ__&Key-Pair-Id=KUT5TJCACFTXG","Anne Braun, a budget analyst with the Department of Legislative Services, told the Health and Social Services Subcommittee on Appropriations that the fiscal 2026 allowance for the Medical Care Programs Administration (Medicaid and MCHIP) is about $13,300,000,000, “just under $270,000,000 less than the fiscal 25 budget,” but noted the fiscal 25 figure included roughly $510,000,000 to cover earlier shortfalls so the fiscal 26 allowance actually represents a slight increase once that is accounted for.

Braun said DLS identified $1,370,000,000 in deficiencies across fiscal 24 and 25 largely tied to higher-than-expected enrollment, utilization and inflation, and recommended a set of deletions and technical amendments to contain costs. Among DLS suggestions were reducing unallocated MCO incentive funds, lowering portions of MCO capitated rates and trimming some proposed provider rate increases.

Why it matters: Medicaid is one of the state’s largest drivers of general fund growth outside K–12 education. Braun told the subcommittee that more than 1.55 million Marylanders were enrolled in Medicaid or MCHIP as of December 2024 and that policy or federal-match changes in Washington could materially increase Maryland’s share of program costs.

Major budget items and DLS recommendations included: the hospital deficit assessment increase (a proposed $50,000,000 in fiscal 25 and $100,000,000 ongoing starting in fiscal 26) and related contingent general fund reductions; a new Medicaid Primary Care Program Fund (DLS recommended deleting a $16,000,000 general-fund placeholder pending special-fund support); DLS recommended reducing $9,200,000 in unallocated 2023 MCO incentives and suggested further reductions in fiscal 26 MCO payments; DLS recommended reducing $132,000,000 across Medicaid and MCHIP in fiscal 26 because its forecast projects lower enrollment and utilization in some groups than the executive budget. Braun also described $51,600,000 in state recoveries from MCO risk-corridor agreements that DLS recommends apply to the fiscal 25 deficiency.

Braun reviewed several programmatic items in the allowance: the Medicaid Enterprise Systems major IT project (14 components with a FY26 allowance of $143,000,000 in the request), phased expansions in school-based health services (phase 1 implemented Jan. 1, 2025), an expanded Assistance in Community Integration Services waiver (ACIS) that moved from a pilot to statewide expansion with a $5,400,000 state share for FY25, and a proposed expansion of biomarker testing beyond cancer with DLS recommending delay of the $8,000,000 dedicated-purpose fund appropriation until costs are clearer.

Agency response: Ryan Moran, Medicaid Director, disputed several DLS reductions and said the department will work with the Department of Budget and Management on supplemental adjustments. Moran said the administration expects some performance incentive payments will be owed based on existing contracts and that Medicaid would need $25,000,000 to cover planned incentives, proposing instead an $11,000,000 reduction rather than DLS’s larger cut. He also pushed back on proposed reductions to provider rates and to the home- and community-based-services provider increases, noting federal review requirements for rate changes and concerns about network adequacy.

The committee heard multiple public witnesses urging the subcommittee to preserve Medicaid expansions and funding lines DLS flagged for cuts. Testimony highlighted the ACIS supportive-housing waiver, behavioral-health provider workforce concerns and the Healthy Babies Equity Act expansion.

The subcommittee did not take final votes during the hearing; members and staff asked for follow-up reports and supplemental budget coordination between MDH, DLS and DBM.

Ending note: Braun recommended continued quarterly reporting on enrollment trends; Moran said MDH and DBM hold monthly convenings with DLS to share updated data. Both the agency and DLS stressed that federal policy changes could materially alter the state outlook and urged the General Assembly to treat some savings recommendations cautiously until federal action is clarified.","Department of Legislative Services analyst Anne Braun told the Health and Social Services Subcommittee that the fiscal 2026 Medicaid and MCHIP allowance is roughly $13.3 billion and recommended several reductions and technical corrections while flagging federal risks and program expansions that could change state costs.","actionData","errors"]

Article not found

DLS and MDH warn enrollment forecasts are volatile; audit raises questions about application processing

Providers warn cuts to E&M, home- and community-based services would worsen workforce crisis

DLS backs MDH scrutiny of MCO HEDIS declines; MDH adds health-equity accreditation and new incentives

DLS: Maryland Medicaid FY26 allowance $13.3B; recommends targeted reductions amid federal uncertainty