G4: Objective 1

Improve equitable access to holistic health care that addresses physical, behavioral, emotional, and cognitive health.

Strategies:

Implement the AHEAD model to expand Maryland’s focus on primary care, population health, prevention, and health equity across age groups.

Overview of Progress Made

  • In September 2025, Governor Moore issued a directive to create a working group of state regulatory agencies to achieve the goals and objectives of the State of Maryland under the AHEAD Model. The working group conducted listening sessions in October and November to receive stakeholder input.

Key Initiatives

Explore policies that incentivize enhanced care delivery models in the home and community that collaborate with community-based organizations, care navigators, and community health workers, such as the Neighborhood Nursing model.

Overview of Progress Made

  • MDOA and the University of Maryland School of Medicine completed the Hospital Transitions Program, a one-year pilot with Maryland Information Network to reduce preventable hospital readmissions among Medicaid- and Medicare-eligible older adults and adults with disabilities.
  • The Maryland Department of Health gathered public feedback to inform the development of the state’s Rural Health Transformation Program proposal to the Centers for Medicare and Medicaid (CMS). CMS must approve or deny all applications by December 31, 2025.

Key Initiatives

  • The Hospital Transitions Program delivered intensive, person-centered support to 62 participants for 120 days after a hospital discharge to guide them through waiver enrollment, paperwork, insurance navigation, and access to essential services. The program delivered a 23 percent reduction in hospital visits within the first month, and a 5 percent reduction at three months. On average, for every $1 spent on care management for program participants, there was a $20.81 reduction in hospital utilization-related costs.

  • Maryland’s Proposal for CMS’s Rural Health Transformation Program (RHTP) focuses on three initiatives: 1. Transform the Rural Health Workforce; 2. Promote sustainable access and innovative care; and 3. Empower rural Marylanders to eat for health.

Expand access to, and utilization of, community-based behavioral health services that address long-term care needs.

Implement a person-centered, trauma-informed approach across publicly-funded programs to ensure older adults and adults with disabilities can effectively make decisions about their care and wellbeing.

Leverage existing state infrastructure to target shortage areas for health providers and direct support professionals to increase access to care among older adults in underserved communities.

Increase access to technology that will enhance the ability of all Marylanders to pursue their best life as they define it through the Technology First initiative by increasing access to the internet and providing resources for digital literacy education, accessible telecommunications equipment, telehealth, assistive technology, and durable medical equipment.

Overview of Progress Made

  • The Office of Statewide Broadband completed a nearly $2 million infrastructure project in September 2025  to bring high-speed internet access to residents and business owners in Smith Island.

Key Initiatives

  • Connect Maryland works to ensure that every Marylander has access to broadband services, regardless of their ZIP code.

Explore policy reform opportunities that incentivize small home alternatives to residential nursing institutions.

Identify policy opportunities to incentivize equitable delivery of medical innovations that impact healthy aging.

Outcomes:

Short-Term (1-3 years)

  • Launch the AHEAD model
  • Identify and promote programs and policies that advance person-centered, trauma-informed care
  • Advance awareness of assistive technology and digital access programs

Mid-Term (4-6 Years)

  • Improve systemic coordination to address social determinants
    of health
  • Identify opportunities to incentivize enhanced care delivery models across state partners

Long-Term (7-10 years)

  • Enhance holistic health of older adults through coordinated care and long-term services and supports