State Government Profile
Governor: Martin O’Malley (D)
Lt. Governor: Anthony Brown (D)
Attorney General: Doug Gansler (D)
Legislature: Senate (Democratic control 35-12), House (Democratic control 98-43)
Legislative Leaders: Senate President Thomas “Mike” Miller, Jr., (D); Speaker of the House Michael Busch (D)
2012 Legislative Session: Jan. 11 – April 9
Key Health Officials: Insurance Commissioner Therese Goldsmith; Secretary of the Maryland Department of Health and Mental Hygiene Joshua Sharfstein; Deputy Secretary, Health Care Financing, Department of Health and Mental Hygiene (Medicaid Director) Chuck Milligan
- Department of Health and Mental Hygiene
- Insurance Administration
- Department of Human Resources
- Maryland Health Care Commission
- Governor’s Office
- State Legislature
State Population: 5,773,552 (2010 US Census data)
Medicaid Enrollment: 901,560 (July 2010, CMS)
Percent Enrolled in Managed Care: 79.46% (July 2010, CMS)
Uninsured Rate: 12.6% (three-year average, 2008-10, US Census Bureau)
Health Reform Projections: 245,966 – 348,140 (total new Medicaid enrollees, low and high participation scenarios, Kaiser Commission on Medicaid and the Uninsured)
1.7 – 3.4% (change in state Medicaid spending, low and high participation scenarios, Kaiser Commission on Medicaid and the Uninsured)
State Fiscal Year (SFY) 2011 Budget Appropriations: $13.094 billion (state general funds)
SFY2012 Projected Budget Shortfall: $1.6 billion (state general funds)
SFY2008 Medicaid Expenditures: $2.58 billion (state general funds)
Federal Medical Assistance Percentage (FMAP) Rates:
53.20% (January – March 2011)
51.20% (April – June 2011)
50.00% (July – September 2011)
50.00% (October 2011 – September 2012)
Health Reform Implementation Activities and Developments
Health Reform Implementation Structure:
Governor O’Malley created the Maryland Health Care Reform Coordinating Council (HCRCC) through an Executive Order to advise the administration on policies and procedures to implement federal health reform. Lieutenant Governor Anthony Brown and Department of Health and Mental Hygiene Secretary John Colmers co-chair the council.
The HCRCC issued an interim report on July 26 that included the following:
- an overview of health care reform and implications for reform in Maryland
- role and mission of the HCRCC
- opportunities and challenges presented by reform implementation
- health care landscape and regulatory environment for implementation
- projected fiscal impact of reform to MD over the next decade ($829 million through 2020)
- timeline for planning and key activities
In order to develop policy recommendations, the HCRCC established six workgroups around specific issue areas:
- Exchange and Insurance Markets Workgroup (final report to Council)
- Entry Into Coverage Workgroup (final report to Council)
- Education and Outreach Workgroup (final report to Council)
- Public Health, Safety Net and Special Populations Workgroup(final report to Council)
- Health Care Workforce Workgroup (final report to Council)
- Health Care Delivery System Workgroup (final report to Council)
The HCRCC released a staff draft of its final report regarding implementation issues and recommendations on December 17.
- Exchange and Insurance Markets Workgroup
- Public Discussion Document for Exchanges: Key Issues for Public Comment
- Synthesis of Public Comments to Workgroup
- Maryland Health Care Commission Comments to HHS on state Exchanges
The state applied for and was awarded an Exchange Planning and Establishment Grant.
Amount Awarded: $999,227
Administrator: Department of Health & Mental Hygiene
Initial Planning Activities:
- Utilize the previously established Maryland Health Care Reform Coordinating Council to outline issues pertaining to: engaging the public, gathering and analyzing public comment, conducting focused research, and developing options for consideration by the Coordinating Council.
- Create an information infrastructure plan that assesses existing information systems, identifies gaps and needs, and proposes strategies to achieve seamless eligibility and enrollment in health coverage.
- Develop an outreach and communications strategy for 2011-2014, including market research to guide the design of the Exchange
- Fund Maryland-specific studies of public and private health insurance coverage and health care expenditures to determine whether to merge the individual and small group markets and whether to provide additional protection against adverse selection, development of governance options for the successful operation of the Exchange, and development of operational plans and a sustainable business model for the Exchange.
- Assess current public sector technological capabilities, current private sector technological capabilities and technology solutions that may be available from the federal government.
- Determine whether the existing public or private sector capacity could be adapted for online public access to facilitate eligibility determination, choice of coverage, application, enrollment, the specific options for connecting an eligibility determination system with other components of the Exchange, and develop an RFP for eligibility system expansion or acquisition.
High Risk Pool: State-Run. The Maryland Health Insurance Plan expects to receive approximately $85 million in federal funding for the federal high risk pool program, which will operate through the end of 2013 when it will be replaced by a state health insurance exchange.
Additional Grants and Funding: The state applied for and was awarded a $1 million rate review grant
Other State Actions, Indicators, and Health Reform Resources:
- Insurance Administration Federal Health Reform Web Page
- Insurance Administration Bulletins to Insurance Companies