CMS Approves Maine’s Waiver to Expand Whole Person Care
The Centers for Medicare & Medicaid Services (CMS) recently approved Maine's Whole Person Care Waiver, expanding MaineCare's ability to support people before they leave jail or prison, reimburse traditional healing services for Wabanaki communities, and strengthen access to substance use disorder and serious mental illness treatment.
The approval represents an important expansion of where and how MaineCare can support health, particularly during reentry to the community from carceral settings, when people are at greatest risk of losing access to care. It also creates, for the first time, a pathway for MaineCare reimbursement of traditional healing services provided through eligible Tribal health programs. The approval also renews Maine’s existing SUD waiver authority, reflecting CMS’ continued approval of Maine’s efforts to expand access to residential treatment and strengthen the broader continuum of community-based substance use disorder care.
The waiver reflects years of collaboration among Maine DHHS, the Department of Corrections (DOC), the Wabanaki Nations, county correctional facilities, the Maine Sheriffs' Association, health care providers, advocates, people with lived experience, and community partners across the state.
More information about the original Whole Person Care Waiver application is available in DHHS’ March 2025 blog post.
What was approved?
CMS approved or continued authority for four major components of Maine’s Whole Person Care Waiver:
Continued authority:
- Substance Use Disorder (SUD) Treatment Services: Continued MaineCare coverage for residential SUD treatment in facilities with more than 16 beds, along with services that more broadly support parents, families, and recovery.
Newly approved authority:
- Pre-Release MaineCare Services: MaineCare will be able to cover certain health care services for eligible people beginning up to 60 days before release from jail or prison.
- Traditional Healing Services: A new pathway for MaineCare reimbursement of eligible traditional healing services provided through Tribal health programs.
- Serious Mental Illness Services: MaineCare coverage for short-term inpatient treatment for eligible adults with serious mental illness in selected settings that meet the federal definition of an ‘Institution for Mental Disease,’ or IMD.
Together, these initiatives represent a significant step forward in Maine's commitment to improving access to care, strengthening transitions between systems, supporting families, advancing culturally responsive health care, and improving outcomes for people who have historically faced barriers to care.
SUD Treatment Services
CMS’ approval allows Maine to continue using federal Medicaid funds to support residential SUD treatment in facilities with more than 16 beds. The waiver also continues services that recognize that recovery often requires support beyond clinical treatment. These include:
- Continued MaineCare coverage for certain parents who might otherwise lose eligibility when a child is removed from the home, supporting parents as they work toward family reunification.
- Parenting supports, including Attachment Biobehavioral Catch-up and Visiting Coaches.
- Home-Based Skills Development services that help eligible parents strengthen daily living skills, community integration, and housing stability.
These investments help Maine maintain access to evidence-based treatment while supporting family relationships, housing stability, recovery, and successful community integration.
Pre-Release MaineCare Services for Justice-Involved Individuals
One of the most significant new components of the waiver changes when MaineCare can begin supporting people returning to the community from incarceration. For the first time, MaineCare will be able to cover certain services for eligible individuals up to 60 days before release from jail or prison.
MaineCare will be required to cover services including:
- Case management and reentry planning
- Medication treatment for substance use disorder
- Certain clinical consultation services for youth
- Medications provided at the time of release
Additional services will be phased in based on facility capacity, including clinical consultations for adults, diagnosis and treatment of priority health conditions such as HIV and hepatitis C, and family planning services.
Approximately 30,600 people are released from Maine prisons and county jails each year, and typically about 70 percent are eligible for MaineCare. Beginning health care and transition planning before release can help people maintain access to medications, mental health care, SUD treatment, and community-based providers during a period of significant vulnerability and improve their chances of health and success upon reentry.
The initiative is intended to:
- Improve continuity of care before and after release
- Strengthen connections to mental health and SUD treatment
- Improve coordination between correctional facilities and community providers
- Reduce preventable emergency department visits and hospitalizations
- Improve health outcomes and support successful reentry
- Reduce deaths during the high-risk period immediately following release
Over the past three years, DHHS staff have visited jail and prison facilities in every county in Maine to understand local needs, infrastructure, and resources. One clear lesson from that work is that implementation cannot be one-size-fits-all. Maine will therefore use a phased, locally informed approach developed in partnership with correctional facilities, counties, providers, and community organizations.
The Maine Sheriffs’ Association (MSA) has served an important role in this work. In the three years since LD 1204 was passed, the MSA has been deeply involved in shaping the reentry waiver, and its support has been crucial to the effort to date. The Department is grateful to both the MSA and the Maine DOC for their support and collaboration.
Traditional Healing Through Tribal Health Programs
For generations, traditional healing practices have supported the health and well-being of Wabanaki people. The Whole Person Care Waiver creates a pathway for MaineCare reimbursement of eligible traditional healing services provided through Indian Health Service, Tribal, and other eligible Tribal health organizations.
The initiative recognizes approaches to health and healing that encompass the physical, mental, emotional, cultural, and spiritual well-being of the whole person.
DHHS will continue working closely with the Wabanaki Nations to develop the benefit, including eligible services, provider types, and the scope of covered services.
This work is intended to:
- Expand access to traditional healing practices for Tribal members enrolled in MaineCare.
- Improve the quality and experience of care.
- Support services that are consistent with members’ cultures, traditions, and communities.
- Recognize and honor longstanding healing practices that have supported Wabanaki health and well-being for generations.
Serious Mental Illness (SMI) Services
The waiver also allows MaineCare to cover short-term inpatient treatment for eligible adults ages 21 through 64 with serious mental illness in selected ‘Institutions for Mental Disease’ (IMD), defined by CMS as facilities with more than 16 beds.
Covered stays may be up to 60 days and will focus on stabilization, treatment of acute behavioral health needs, and transition back to community-based care.
The goal is to strengthen Maine’s behavioral health continuum by improving access to clinically appropriate treatment while supporting recovery and long-term stability in the community.
When will the initiatives be implemented?
CMS approval is an important milestone, but significant work remains before these services become available. Current anticipated implementation dates include:
- SUD Treatment Services: Already effective and now renewed
- Traditional Healing Services: October 1, 2027
- Pre-Release MaineCare Services: Phased implementation across Maine’s jails and prisons beginning July 1, 2028
- SMI-IMD Services: July 1, 2028
These timelines are tentative and may evolve as implementation planning continues.
What about the other proposed components of the waiver?
Maine’s original Whole Person Care Waiver application included several additional proposals that remain under CMS review. The remaining proposals include:
- Food is Medicine: Services such as medically tailored meals, fruit and vegetable prescriptions, and nutrition supports.
- Recuperative Care: Short-term care and clinical support for people experiencing homelessness who are recovering from an illness, hospitalization, or medical procedure.
- Contingency Management: An evidence-based SUD treatment approach that uses incentives to support treatment participation and recovery.
DHHS will provide additional information as CMS completes its review of these proposals, including any decisions and next steps for implementation.
How do I stay informed?
MaineCare members and the public do not need to take any action at this time. Many of the newly approved services will require additional planning, rulemaking, and implementation before they become available.
As that work moves forward, DHHS will share updates about when services become available, who may be eligible, and how to access them.
MaineCare members and the public can:
- Visit the MaineCare website for updates.
- Watch for future MaineCare member communications about new or expanded services.
- Provide public comment or attend a public hearing during upcoming rulemaking for these components. Information about proposed rules will be available on DHHS’ Rulemaking webpage.
- Follow MaineCare social media channels for implementation updates and other information.
Providers and community partners can:
- Subscribe to MaineCare provider e-messages for implementation guidance and updates.
- Visit the MaineCare website for additional information.
- Participate in upcoming rulemaking and public hearings.
- Attend the upcoming Justice Conference, if applicable. Additional details will be shared as they become available.
The Whole Person Care Waiver reflects Maine’s broader commitment to ensuring that health care does not begin or end at the boundaries between systems. Whether someone is receiving treatment for substance use disorder, experiencing an acute mental health need, preparing to return home after incarceration, or seeking care rooted in the traditions of their community, MaineCare’s goal is to support continuity, dignity, and health through transitions and throughout people’s lives.
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