DRM Opposes DHHS Proposal for 1115 Waiver

Posted on March 18, 2019

by Mark C. Joyce, Esq.

Medicaid is a health insurance program that is funded jointly by states and the federal government. In Maine this program is known as MaineCare. This insurance provides health coverage to over 200,000 Mainers, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. MaineCare is administered by the Maine Department of Health and Human Services (DHHS), according to federal requirements.

The express purpose of the federal Medicaid Act is to enable each State “to furnish medical assistance on behalf of [individuals] whose income and resources are insufficient to meet the costs of necessary medical services” and to provide “rehabilitation and other services to help such families and individuals attain or retain capability for independence or self-care.” [1]

Not surprisingly Medicaid bars the use of federal funds for people aged 22-64 who are served in large institutions, including any facility with a capacity of over sixteen beds. This is commonly known as the “IMD exclusion.”[2]

The federal requirement that the funding of health care services be designed in order to ensure that individuals attain and maintain their independence is also the cornerstone of the Maine Department of Health and Human Services obligation to individuals with mental disabilities under the terms of a court approved class action settlement agreement. This agreement is commonly known as the “AMHI Settlement Agreement”.[3]

This prioritization of mental health services in the community to ensure that individuals are not inappropriately hospitalized is contained within the terms of the Settlement Agreement which provides that:

“All services within the comprehensive mental health system shall be oriented to supporting class members to continue to live in the community and to avoid hospitalization.”

Notwithstanding the above, on February 22, 2019 the Maine Department of Health and Human Services issued a draft proposal it intends to submit to the United Stated Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) seeking a waiver of this IMD exclusion.

This proposal fundamentally shifts the focus from ensuring the availability of adequate mental health services in the community in order for people with mental disabilities to avoid unwarranted institutionalization, to strategies on how to pay for fund such institutionalization.

DRM strongly opposes this waiver request and submitted its comments to DHHS at public hearings on March 6 & 7, 2019.

Click here for information concerning the proposed IMD exclusion waiver.

A copy of the DRM’s comments detailing its opposition to this request can be found here (PDF).

[1] 42 U.S.C. § 1396-1.

[2] IMD is an acronym that stands for “Institutes for Mental Diseases” which appeared in the original Medicaid Act passed in 1965. This outdated nomenclature has never been amended.

[3] For more information on this agreement, please see

Learn more about: