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Hilltop Releases Third Report on Medicare/Medicaid Cross-Payer Effects

The Hilltop Institute has released a new report entitled, Examining the Medicare Resource Use of Dually Eligible Medicaid Recipients. The report, authored by Anthony M. Tucker, PhD, Karen E. Johnson, MS,
Yi Huang, PhD, and Tonya Brewer, MPH, is the third in a series that explores the cross-payer effects of providing Medicaid long-term supports and services (LTSS) on Medicare acute care resource use. The report reflects an exploratory analysis of the relationships between Medicare and Medicaid resource use to address the question: Does providing Medicaid LTSS influence dually eligible Medicaid recipients’ use of Medicare resources and, if so, how and to what extent? Report results suggest two general aspects of these effects: (1) Medicaid LTSS provided in the community are associated with an increase in the number of Medicare services used with no, or limited, additional Medicare costs overall, and (2) Medicaid institutional supports offset Medicare resource use overall. The report also highlights analytic methods used, including propensity score matching techniques.

The first report, A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data, presented a basic analytical framework for analyzing Medicare and Medicaid data together.
The Hilltop Crossover Framework
was introduced as an orienting reference device to understand the relationship between Medicare and Medicaid claims.

The second report, Examining Rate Setting for Medicaid Managed Long-Term Care, examined overall patterns of resource use in further detail, including the presentation and simulation of a rate setting system to cover the Medicaid portion of costs associated with coordinated care in an integrated Medicaid and Medicare environment. The relationship between risk adjustment based on CMS Hierarchical Condition Categories that is used to establish payments to Medicare Advantage plans and Medicaid resource use is also explored.

The overarching study, Medicaid Long-Term Care Programs: Simulating Rate Setting and Cross-Payer Effects, which focuses primarily on issues related to setting Medicaid payment rates, is being conducted by Hilltop on behalf of the Maryland Department of Health and Mental Hygiene with funding support from the Robert Wood Johnson Foundation Changes in Health Care Financing and Organization (HCFO) initiative (Grant # 63756). Although based on Maryland data alone, the broader objective of the reports drawn from this study is to provide administrators and analysts across states and at the federal level with a framework and background to approach analyses that integrate Medicare and Medicaid resource use.

To learn more about the study, contact Anthony M. Tucker, PhD, project leader.


The Hilltop Institute at the University of Maryland, Baltimore County (UMBC) is a nationally recognized research center dedicated to improving the health and social outcomes of vulnerable populations. Hilltop conducts research, analysis, and evaluations on behalf of government agencies, foundations, and other non-profit organizations at the national, state, and local levels.

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