Medicaid Coverage for Former Foster Care Youth from a Different State and Substance Use Disorder Section 1115 Demonstration
The Department of Human Services (Department) is making available for public review and comment the proposed renewal application for extension of the Section 1115 Medicaid Demonstration (Demonstration) titled
Medicaid Coverage for Former Foster Care Youth from a Different State and SUD Demonstration (Project Number: 11-W-003083/3). The effective dates of the current approved Demonstration are October 1, 2017 through September 30, 2022. The extension requested will be for an additional 5 years through September 30, 2027.
Demonstration Extension Application Documents are available here:
Description of the Demonstration
This section 1115(a) Demonstration enables the Commonwealth to provide Medicaid coverage to out‑of‑state former foster care youth (FFCY) under age 26 years who were in foster care under the responsibility of another state or tribe in such other state when they turned 18 (or such higher age as the state has elected for termination of federal foster care assistance under title IV‑E of the Social Security Act [the Act]), were enrolled in Medicaid at that time, and are now applying for Medicaid in the Commonwealth.
The objectives of the FFCY Demonstration component are to increase and strengthen overall coverage of FFCY and improve health outcomes for this population.
Through the substance use disorder (SUD)/opioid use disorder (OUD) amendment effective July 1, 2018, the Commonwealth intends to maintain critical access to OUD and other SUD services and continue delivery system improvements for these services to provide more coordinated and comprehensive SUD/OUD treatment for Medicaid beneficiaries. This Demonstration component will provide the Commonwealth with authority to provide high quality, clinically appropriate SUD treatment services in residential and inpatient treatment settings that qualify as an Institution for Mental Disease (IMD). The Demonstration will also build on the Commonwealth's existing efforts to improve models of care focused on supporting individuals in the community and home, outside of institutions, and strengthen a continuum of SUD services based on the American Society of Addiction Medicine (ASAM) criteria.
The Commonwealth will test whether the SUD section 1115 Demonstration amendment is likely to assist in promoting the objectives of Medicaid by achieving the following results:
1. Increased rates of identification, initiation, and engagement in treatment.
2. Increased adherence to and retention in treatment.
3. Reductions in overdose deaths, particularly those due to opioids.
4. Reduced utilization of emergency department (ED) and inpatient hospital settings for treatment where the utilization
is preventable or medically inappropriate through improved access to other continuum of care services.
5. Fewer readmissions to the same or higher level of care (LOC) where the readmission is preventable or medically inappropriate.
6. Improved access to care for physical health (PH) conditions among beneficiaries.
Impacts of the Demonstration
The Demonstration will not affect the health care delivery system and cost sharing (premiums, co-payments, and deductibles) required of individuals under the Demonstration. Under the Demonstration, the only change in eligibility is the FFCY coverage outlined above, expanding eligibility for out‑of‑state former foster care youth under age 26 years who were in foster care under the responsibility of another state or tribe in such other state when they turned 18. There are fewer than 50 FFCY on the Demonstration. The only change in benefit coverage is that, under Managed Care, Medicaid now reimburses for services provided to individuals 21-64 years of age in Institutions for Mental Diseases (IMDs) that provide SUD treatment and services.
In the first year of the Demonstration, the Commonwealth provided coverage for residents of IMDS for 90,500 months. That number dropped to about 81,000 months of IMD resident coverage by the end of the third year as the ASAM placement criteria and complete continuum of care was implemented. An estimate of the aggregate expenditures in the SUD portion of the Demonstration is included in the Demonstration Extension Application documents included with this announcement.
List and Programmatic Description of Waiver and Expenditure Authorities
Waiver Authority Requested
The Commonwealth requests an extension of the waiver authority granted in the original Demonstration. The Commonwealth did not need to request any expenditure authority to provide Medicaid coverage under the new adult group. The Commonwealth submitted an eligibility State Plan Amendment (SPA) under S50 to cover the group for youth above 133 percent Federal Poverty Limit (FPL) and requests waivers of sections 1902(a)(8) and 1902(a)(10) to limit this State Plan group coverage to FFCY who were in Medicaid and foster care in a different state. The eligibility SPA under S50 was approved on September 29, 2017 with an effective date of October 1, 2017. This waiver authority does not apply to the SUD component of the Demonstration:
Provision of Medical Assistance Section 1902(a)(8) and 1902(a)(10) — To the extent necessary to permit the Commonwealth of Pennsylvania to limit the provision of medical assistance (MA) (and treatment as eligible) for individuals described in the eligibility group under section 1902(a)(10)(A)(ii)(XX) of the Act and the Medicaid State Plan to only FFCY who are under 26 years of age, were in foster care under the responsibility of another state or tribe on the date of attaining 18 years of age (or such higher age as the state has elected), and who were enrolled in Medicaid on that date.
Expenditure Authority Requested
The Commonwealth requests a renewal of the expenditure authority granted in the original Demonstration:
Residential and Inpatient Treatment Services for Individuals with SUD. Expenditures for otherwise covered services furnished to otherwise eligible individuals enrolled in managed care who are primarily receiving treatment and withdrawal management (WM) services for SUD who are short‑term residents in facilities that meet the definition of an IMD as described in the Special Terms and Conditions #28 of the approved Demonstration.
Public Hearing Schedule
The Department will conduct two virtual public hearings to receive comments from the public regarding the proposed Demonstration renewal application. These meetings will be held as follows:
The Department will also present updates on the Demonstration renewal application at the Medical Assistance Advisory Committee (MAAC) meeting on January 27, 2022. You can register for the MAAC meeting at the link below:
Public Comment Process
The 30-day public comment period will begin on January 15, 2022, and end on February 15, 2022. Persons who wish to speak at one of the public hearings to provide comments on the proposed Demonstration renewal application should schedule a time by calling (717)705-8154 or emailing
email@example.com. Individuals may also send a written request to Mr. Charles Tshudy, Bureau of Policy, Planning and Program Development, Office of Mental Health and Substance Abuse Services, 11th Floor, Commonwealth Tower, 303 Walnut Street, Harrisburg, PA 17101 during the comment period.
Even if you are not planning to speak at the hearing to provide comments, but are attending, please email your name, organization, email, and phone number to
firstname.lastname@example.org so we have your contact information for our records.
Individuals may also submit written comments at any of the public hearings or by email to
email@example.com or by mail to Mr. Charles Tshudy at the address mentioned above. The Department will consider all comments received by February 15, 2022, in developing the final Demonstration renewal application.
Persons with a disability who require auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).