Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Hcbs Waivers topic
No spam. Unsubscribe anytime.
Maryland seeks ways to reduce HCBS waiver registries; staffing and provider capacity cited as constraints
Summary
The Department of Health told the subcommittee it increased outreach and is pursuing data clean-up and process changes to reduce Home and Community-Based Services (HCBS) waiver registries, but staffing shortages and limited provider capacity continue to slow enrollment.
The Maryland Department of Health told the Health and Social Services Subcommittee on Jan. 29 that it has increased outreach and data-cleaning measures to reduce waiting registries for Home and Community-Based Services (HCBS) waivers but continues to face staffing and provider-capacity constraints.
DLS analyst Ann Bridal emphasized that registries and waiting lists vary by waiver. The Community Options Registry had more than 20,000 individuals at the end of fiscal 2024, while the Developmental Disabilities Administration (DDA) waivers combined had under 4,000. MDH reported outreach increases and a legislative requirement to mail 600 Community Options invitations monthly; as of December 2024 the department was mailing 700 invitations each month.
Return and processing rates: DLS reported a roughly 29% return rate on mailed Community Options applications and said about 84% of returned applications remained pending in the month they were sent, largely because MDH lacks staff to process eligibility determinations. MDH reported a 37% vacancy rate in positions handling application processing and eligibility determinations for Community Options in fiscal 2024.
Steps taken and remaining gaps: MDH said it is working with the Hilltop Institute and Vital Records to remove deceased individuals from registries and expects that cleanup to be complete by March 31. MDH said it is improving screening with the Department of Aging to ensure registrants meet criteria before being added to or retained on the registry. The department has also used a utilization-control contractor since June 2024 to assist with backlogged plan-of-service reviews.
Funding and the End the Wait Act: MDH said that a dedicated-purpose account created in fiscal 2023 initially held $30 million to support waiver expansions; about $22.7 million has been spent or appropriated and roughly $7.3 million remains. DLS noted that $16 million was budgeted for End the Wait activities across fiscal 2024–25, with $10 million reduced through Board of Public Works cost-containment actions and a proposed transfer of the remaining $6 million in fiscal 2026 back to the general fund as part of further cost containment. DLS asked MDH for an updated timeframe to meet the End the Wait Act's 50% reduction goal and whether a registry-to-wait-list transition is feasible and adequately funded.
Capacity constraints and waiver changes: MDH cited limited provider capacity and shortages of direct-support professionals as barriers to enrolling registrants. The department told the panel it plans to seek a new model waiver to expand capacity for the model waiver population (capped at 200 slots); the governor's fiscal 2026 allowance does not include funding for a new technology waiver, and MDH said it had not applied for that waiver because no funding was included in the allowance.
DLS requested updated timelines, feasibility analysis for registry-to-wait-list options, and details on how remaining dedicated-purpose funds will be used.
