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The Hilltop Institute has just released A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data as a resource guide for analysts who plan to integrate data on Medicare and Medicaid service use and costs. The Hilltop Crossover Framework is introduced in the guide as an orienting reference device for linked Medicare and Medicaid claims, and is based on a two-by-two format whereby data are arrayed by category of service-with specific reference to Medicaid crossover claims-in order to highlight the relationships between government programs and service use. The term "crossover" refers to Medicaid claims that reflect Medicare patient liability costs that state Medicaid programs cover on behalf of persons eligible under both programs-"dual eligibles" or "duals," for short. The guide is also intended as a general introduction to Medicare and Medicaid benefits and attendant relationships for analysts who may be less familiar with one or both programs.
The guide uses The Hilltop Crossover Framework to array all claim costs for continuously enrolled duals in Maryland during calendar year 2006 as an overview of the relationships between Medicare and Medicaid resource use. As illustrated below, Medicare and Medicaid service use and costs are aggregated in the left and right sections of the framework, respectively. Services that are formally linked across program data sources are shown in the top sections of the framework. Services that are not formally linked are shown in the bottom of the framework.
 The guide is the first of several reports that will be forthcoming from a study to examine the cross-payer effects of providing Medicaid long-term care supports and services on Medicare acute care resource use. The study is undertaken 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). This project, Medicaid Long-Term Care Programs: Simulating Rate Setting and Cross-Payer Effect, will focus, in particular, on issues related to setting Medicaid payment rates. Although limited to Maryland data, results from this study will be broadly relevant to other states as they examine ways to better integrate/coordinate health service programs for duals.
To learn more about The Hilltop Crossover Framework and to see the study's initial findings, click here.
To learn more about the study, contact Dr. Tony Tucker, project leader.
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