The Department of Health and Human Services Introduces Maine's Whole Person Care Waiver

March 28, 2025

Maine’s DHHS is applying for an 1115 waiver. In this post, we’ll share the basics you need to know about what this waiver is, and why DHHS is applying for it.

What is a Medicaid 1115 waiver?

A Medicaid 1115 waiver is a federal tool that allows states to test new approaches to delivering Medicaid services that would not normally be allowed under federal rules. These waivers allow states to test and measure the effectiveness of new policy approaches.

CMS recognizes that states have an interest in testing out certain areas of flexibility. In these cases, CMS may develop certain types, or templates, of 1115 waivers for which states may apply. When a state builds off work that CMS has already approved in other states’ waivers, CMS is more likely to approve the state’s waiver application. DHHS is taking this approach and is building off other states’ 1115 waivers that have already been approved by CMS.

One type of 1115 waivers that many states have taken advantage of, is a waiver that allows states to suspend the long-standing federal "Institutions for Mental Disease (IMD) Exclusion." The IMD Exclusion prohibits the use of federal Medicaid funds for care provided to adult patients in mental health and substance use disorder (SUD) residential treatment facilities larger than 16 beds. Under these “IMD Exclusion” waivers, states are allowed to use federal Medicaid funds to pay for this care.

What is Maine’s current SUD Care Initiative 1115 waiver?

Maine currently has an approved 1115 IMD Exclusion waiver that is specific to services for substance use disorders (SUD). It allows Maine to use federal Medicaid funds to pay for residential SUD treatment in facilities with more than 16 beds. In addition, the current waiver includes three initiatives that focus on providing supports to help enable parents to participate in community-based treatment and strengthen family relationships:

  1. Maintenance of Medicaid Coverage: continues MaineCare coverage for 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, with the goal of family reunification.
  2. Parenting Support Services: provides two key services, Attachment Biobehavioral Catch-up and Visit Coaching, to help parents with a SUD improve their understanding of child development, enhance parenting skills, and strengthen the parent-child bond.
  3. The Home-Based Skills Development program provides daily living skills development, community integration, and housing support services to eligible parents with an SUD. This existing SUD IMD Exclusion waiver is set to expire on December 31, 2025, and DHHS is applying to renew it for an additional five years.

What is included in Maine’s new 1115 waiver application?

As part of its renewal application for its current SUD waiver, DHHS is applying for additional waiver flexibilities. These new waiver flexibilities will include the following:

  • Serious Mental Illness (SMI) IMD Exclusion
  • Pre-Release Medicaid Services for Justice-Involved Individuals
  • Health-Related Social Needs
  • Traditional Healing Services provided by Indian Health Services or Tribal non-profit organizations To reflect the proposed changes, the waiver's name is being updated from the "Maine Substance Use Disorder Care Initiative" to the "Maine's Whole Person Care Waiver."

This will reflect a broader focus on overall health and well-being beyond substance use alone.

As the new name suggests, the overall vision is to create a whole-person care approach, where healthcare encompasses not only medical and behavioral health services but also addresses health-related social needs, such as food insecurity, continuity of healthcare during transitions from institutions (e.g., hospitals, jails, prisons, psychiatric facilities, etc.) to the community, and improves access for Maine’s tribes to traditional healing services.

The Whole Person Care Waiver has three main goals to help improve healthcare access, particularly for populations with high needs:

  1. Maximize access to high-quality behavioral health services.
  2. Improve health outcomes during transitions from institutions.
  3. Develop and maintain infrastructure to support reentry and services for health-related social needs for individuals leaving jails and prisons.

What exactly does this new Whole Person Care Waiver propose to do?

Severe Mental Illness (SMI) IMD Exclusion Waiver Services:This initiative expands the current IMD Exclusion waiver for SUD to also apply to psychiatric facilities that serve members with SMI. This new initiative_ _will provide reimbursement for clinically appropriate inpatient psychiatric services for individuals aged 21-64 with SMI that are already approved under the Maine Medicaid State Plan. These services include short-term stays for up to 60 days in public, private, and out-of-state IMD for Medicaid enrollees living with mental health needs. Within Maine, this would include the following types of facilities:

  • Two private facilities: Spring Harbor Hospital and Acadia Hospital
  • One public facility: Dorothea Dix Psychiatric Center While the primary change in these waivers is related to payment for inpatient services, states are required to meet milestones and overarching goals reflecting a comprehensive, high-quality behavioral health system. The goal is to, wherever possible, support the ability of individuals to flourish in their communities.

Pre-Release Medicaid Services for Justice-Involved Individuals: In 2023 the Maine State Legislature passed H.P. 764 – L.D. 1204 requiring MaineCare to apply for the 1115 Re-entry Waiver by April 2025. This initiative is aimed at improving health outcomes for current residents of jails and prisons, and individuals recently released from incarceration. The proposal is to use MaineCare to cover case management, medication-assisted treatment, and medication dispensing upon release to help reduce hospital visits and all-cause deaths by ensuring timely and consistent access to care.

Health-Related Social Needs (HRSN): HRSN are social and economic needs that individuals experience that affect their ability to maintain their health and well-being. The waiver includes two new initiatives to address HRSN.

  1. Food is Medicine: supporting pilot programs designed to address access to healthy foods, knowing that nutritious foods support people being their healthiest selves.
  2. Recuperative Care: improving health outcomes for people experiencing homelessness who have a serious illness by developing three recuperative care pilot programs. Recuperative Care programs work to fill the gap that exists between a shelter and an acute hospital stay.

Traditional Healing Services: This new initiative addresses the need for culturally relevant, holistic care for Native American populations in the state. DHHS is collaborating with the Wabanaki Nations to finalize the specifics of the request, including eligible services, provider types, and the exact scope of benefits.

How long will it take to implement Maine’s Whole Person Care Waiver?

After the waiver is submitted to the federal government for approval, it can take years to receive approval for implementation. DHHS plans to implement the waiver initiatives slowly over time, ensuring that resources are in place to achieve each goal and that services provided through MaineCare meet high standards. Initiatives in this waiver will be subject to availability of appropriations in the next biennium.

How can I be involved?

There are a few ways you can learn more about the waiver and engage with the Department in the waiver application process:

  • Review the application:The full application is available here.

  • Share your feedback:We invite you to share your thoughts with us. DHHS is accepting comments through 11:59 pm, April 22, 2025. Any interested party may obtain a copy of the waiver application by calling Lisa Weaver, MaineCare’s Policy Planning and Research Associate, at (207) 624-4050 or emailing lisa.weaver@maine.gov. See the full public notice document and waiver application draft and to submit comments.

  • Attend the public hearings:Maine DHHS plans to host two public hearings on April 3, 2025, and April 10, 2025. For more information, the public notice and information for the hearings on this waiver are available online.

    • Public Hearing 1: Statewide Virtual/Teleconference Hearing
    • Date: April 3, 2025
    • Time: 11:30 AM
    • Location: Virtual & Teleconference link  
    • Public Hearing 2: In-Person Hearing in Augusta
    • Date: April 10, 2025
    • Time: 9:00 AM
    • Location: 109 Capitol St, Augusta, Maine 04330
    • Room A & B First Floor

DHHS will also post a finalized draft of the waiver application online, including a summary of public comments received, once it becomes available. The Department will continue to share updates and more details about the major phases of this waiver in future blog posts and through MaineCare electronic noticing channels.