When it comes to health care reform, Maryland is in a unique situation thanks to its decades-old Medicare waiver. That waiver may be in jeopardy, however, as state officials push to keep its $1 billion in reimbursements from the federal government.

The agreement, enacted in 1977, lets the state set its own Medicare and Medicaid payment rates — the only state in the country with that ability. There’s a condition, though — the rate of growth in state payments cannot exceed the rate of growth in national payments.