News & Bulletins Archive

The Hilltop Institute assisted the New Mexico Human Services Department with preparing the renewal applications to the Centers for Medicare and Medicaid Services (CMS) for the Mi Via (My Way) self-directed waiver program. The program operates under two Section 1915(c) Medicaid waivers—one for individuals who might otherwise require care in a nursing home and the other for individuals with developmental disabilities. With Mi Via, participants can avoid institutionalization and remain at home or in the community. Participants manage their own budget and may choose from a wide array of home and community-based services, ranging from supports for community living to health and wellness supports. Hilltop worked with New Mexico on the initial design of Mi Via, originally launched in 2006. Mi Via is recognized as one of the most innovative Medicaid self-directed waiver programs in the country.

The State Health Access Reform Evaluation (SHARE) has just released an issue brief entitled Using Information from Income Tax Forms to Target Medicaid and Chip Outreach: Preliminary Results of the Maryland Kids First Act. The brief discusses the preliminary results of Hilltop’s evaluation of the outreach effort of Maryland’s Kids First Act. Maryland is one of the first states in the country to use information from state income tax forms to identify and enroll Medicaid and CHIP-eligible children. As a result of this innovative approach, SHARE commissioned the Maryland Department of Health and Mental Hygiene and its partner, The Hilltop Institute, to evaluate the outreach strategy. Hilltop Director of Medicaid Policy Studies David Idala, M. A., is principal investigator and research team leader. The brief identifies ten lessons learned from the experience so far, addressing issues such as data-sharing, health literacy, inclusion/exclusion criteria, tracking mechanisms, and the circumstances under which legislation is necessary in order to implement tax-based outreach. The project is funded by SHARE, a national program of the Robert Wood Johnson Foundation®, with direction by the State Health Access Data Assistance Center at the University of Minnesota School of Public Health. To view the brief, click here.

The State Health Access Reform Evaluation (SHARE) has released an issue brief entitled, Using Information from Income Tax Forms to Target Medicaid and Chip Outreach: Preliminary Results of the Maryland Kids First Act. The brief discusses the preliminary results of Hilltop’s evaluation of the outreach effort of Maryland’s Kids First Act. The view the brief, click here. To view the bulletin, click here.

Hilltop Executive Director Charles Milligan gave a panel presentation at the National Academy for State Health Policy’s Maximizing Enrollment for Kids Conference in Washington, D.C. on September 25, 2009. The panel, Streamlining Enrollment: One-Lane Highway to Express Lane, addressed the new CHIPRA Express Lane Eligibility option and early state experiences with automated enrollment strategies, including Maryland’s Kids First Initiative. Milligan’s presentation, entitled Maryland’s Kids First Act: Using Tax Forms to Identify Medicaid/SCHIP-Eligible Children, described the Act and its requirements; Maryland’s implementation; and the Hilltop evaluation of the outreach effort of using state income tax forms to identify and enroll uninsured but eligible children in Medicaid or CHIP. To view the presentation, click here.

Hilltop Senior Research Analyst Ian Stockwell, M.A., gave a presentation entitled Data Integration in HCBS Program Development at the National Association of State Units on Aging 45th annual membership meeting in Denver, Colorado on September 23, 2009. The presentation discussed the potential that state policymakers now have to pull individual-level information together to form a complete picture of a program population through data integration. This method can provide a wealth of demographic and health status information for program building, as well as help predict service use, set appropriate individual budgets, and determine potential cost savings. Stockwell provided a brief overview of data sources currently available in most states; discussed the potential of new web-based information systems and provided a case study of a system currently in use; and discussed possible metrics and benchmarks, as well as some “best practices” on how to combine disparate datasets. To view the presentation, click here.

The Hilltop Institute has released a new report entitled, Examining Rate Setting for Medicaid Managed Long-Term Care. The report, authored by Anthony M. Tucker, PhD, and Karen E. Johnson, MS, is the second in a series that explores the cross-payer effects of providing Medicaid long-term supports and services on Medicare acute care resource use. Patterns of Medicaid eligibility, as well as resource use under both Medicare and Medicaid, are examined primarily within the context of service use-based groups that can be used to set rates for Medicaid capitation payments for managed long-term care. The view the report, click here. To view the bulletin, click here.

The Hilltop Institute is pleased to present the proceedings of the sixth Hilltop Symposium, Home and Community-Based Services (HCBS): Examining the Evidence Base for State Policymakers, convened on June 11, 2009, at UMBC. The Hilltop Symposium brought together more than 130 policymakers, health services researchers, and healthcare practitioners, including some of the nation’s leading HCBS researchers and policy experts, from across the country to discuss the measures and evidence to examine whether the expansion of home and community-based services has produced desired outcomes (quality, choice, cost, satisfaction, and safety) in the long term for older adults and persons with disabilities. The day was divided into four sessions and was highlighted by a keynote address, a luncheon address, and concluding reflections. To view the bulletin, click here.

The Hilltop Institute and its partner, the Maryland Institute for Policy Analysis and Research (MIPAR), at the University of Maryland, Baltimore County, have been awarded a National Institute on Disability and Rehabilitation Research (NIDRR) grant for a field-initiated project entitled Health Care Disparities in Access and Utilization among Individuals with Disabilities, scheduled to begin on October 1, 2009. The study will combine national survey data from the National Health Interview Survey (NHIS) and the Medical Expenditure Panel Survey (MEPS), pooling six years of data. Three measures of access and five measures of utilization will mirror those included in the series of Agency for Healthcare Research and Quality National Healthcare Disparities reports. The study’s analytic strategies will allow researchers to identify subpopulations with disabilities that are disparately impacted by system and individual characteristics, ‘doubly underserved’ individuals due to system-level and individual characteristics Researchers will identify factors which have the potential capacity to affect practice and policy, with the aim of elimination of disparities in health and function among individuals with disabilities. Annette Snyder, PhD, MSN, Hilltop’s director of clinical and quality management, is a co-investigator on the grant and will lead Hilltop’s project team. Adele Kirk, PhD, assistant professor of public policy, is also a co-investigator. Nancy Miller, PhD, associate professor of public policy, is the principal investigator and project leader.

The Hilltop Institute sponsored the sixth Hilltop Symposium at which national experts discussed the measures and evidence to examine whether the expansion of home and community-based services (HCBS) has produced desired outcomes (quality, choice, cost, satisfaction, and safety) in the long term for older adults and persons with physical disabilities. The day was divided into four sessions and highlighted by a keynote address, a luncheon address, and concluding reflections. More than 130 policymakers, health services researchers, and health care practitioners from across the country, including the leading experts in the field, participated in the event. Learn more about the Symposium.

Harriet L. Komisar, PhD, a health economist with more than fifteen years of experience researching topics related to long-term care financing and health policy, has joined The Hilltop Institute as a senior research analyst in the Long-Term Supports and Services (LTSS) unit. In this capacity, she will assume a leadership role in developing and managing research and policy analysis related to LTSS for older adults and other persons with disabilities. Prior to joining Hilltop, Komisar was a research professor in the Health Policy Institute at Georgetown University. While at Georgetown, her research focused on assessing needs and access to long-term care for individuals eligible for both Medicare and Medicaid—dual eligibles—and developing and modeling alternatives for long-term care financing. Previously, Komisar was a principal analyst at the U.S. Congressional Budget Office, where she worked on issues related to Medicare’s payment policies.

As part of its role to provide consultation and technical assistance to the Maryland Department of Health and Mental Hygiene, Hilltop staff made two presentations before the Payment Advisory Committee Workgroup of the LTC Reform Committee on September 2, 2009. Charles J. Milligan, Jr., JD, Hilltop’s executive director, gave a presentation entitled, Nursing Facility Payment Policy: Comparing Maryland to Other States, in which he described findings from a Hilltop study that examined the Medicaid nursing facility (NF) payment systems of all 50 states and the District of Columbia, and then compared Maryland’s payment system to that in other states. To view this presentation, click here. Anthony M. Tucker, PhD, Hilltop’s director of special projects, gave a presentation entitled Resource Utilization Groups (RUGs), in which he described RUGs, the LTC minimum data set (MDS) as it is used to assign RUGs to NF residents, and Hilltop’s process to refine MDS data to examine patterns of care. Hilltop refined MDS data were also used to show the distribution of Maryland’s NF residents, as well as measures of length of NF stays, by RUG level and payor. To view this presentation and accompanying exhibits, click here.

Hilltop Executive Director Charles Milligan, JD, MPH, was the luncheon keynote speaker at the AcademyHealth State Coverage Initiatives Annual Meeting on July 30, 2009 in Albuquerque, New Mexico. In his speech on health reform, Milligan outlined the current efforts to pass federal health reform and its potential impact on states and analyzed the federal-state relationship in the context of comprehensive reform. In addition, Milligan participated on a panel entitled Medicaid and the Children’s Health Insurance Program: The Case for Increased Outreach and Enrollment Efforts, which highlighted the enhanced importance of state efforts to enroll eligible populations in public coverage programs. The session focused on ways to increase enrollment, and the increased incentives for doing so under Children’s Health Insurance Program Authorization Act (CHIPRA), through examples such as express lane eligibility, facilitated enrollment, intensive application assistance, automated eligibility, etc. The session also examined Maryland’s lessons learned in creating a system to identify and enroll uninsured children via income tax forms. Milligan’s presentation, entitled Maryland’s Kids First Act: Using Tax Forms to Identify Medicaid/SCHIP-Eligible Children, described the Kids First Act, Maryland’s implementation activities, and discussed the initial results of Hilltop’s study of the effectiveness of the state’s outreach efforts. The study was commissioned by the Robert Wood Johnson Foundation’s State Health Access Reform Evaluation (SHARE) program. To view the presentation, click here.

Hilltop researchers have been actively presenting the findings of their study of employer participation in New Mexico’s State Coverage Insurance (SCI) program. The study, funded by the Robert Wood Johnson Foundation’s State Health Access Reform Evaluation (SHARE) program, determined what factors influence small business employer participation or non-participation in SCI, one of the state’s efforts to expand health coverage to low-income New Mexicans who are not eligible for Medicaid. Anna Sommers, PhD, a Hilltop senior research analyst and the project’s principal investigator, released the study’s findings at the 2009 AcademyHealth Annual Research Meeting in Chicago, Illinois on June 27 and June 30. Sommers participated on two panels: Early Results from the State Health Access Reform (SHARE) Program, and The Lab Reports: Evaluating States’ Actions to Expand Access & Coverage. On July 6, in the Pueblo of Laguna, New Mexico, Charles Milligan, JD, MPH, Hilltop’s executive director and an investigator on the project, included study results in his testimony before the New Mexico Legislative Health and Human Services Committee about the new Children’s Health Insurance Program Reauthorization Act (CHIPRA) and its impact on the SCI program. Changes in what CHIP funds can be used for have the potential to reduce funding for SCI, and the state is exploring its options in regard to sustaining the program. Most recently, on July 31, at the State Coverage Initiatives Annual Meeting in Albuquerque, New Mexico, Asher Mikow, MHA, a Hilltop research analyst and investigator on the project, and Mari Spaulding-Bynon, JD, Insure New Mexico! Bureau Chief at the New Mexico Human Services Department and co-principal investigator of the project, presented research results in a session entitled Research & Evaluation of State Reforms. Dissemination activities are also occurring within New Mexico, including presentations to program stakeholders, and other interested parties. A number of issue briefs are expected to be published in the fall by both the Robert Wood Johnson Foundation’s SHARE program and The Hilltop Institute. View the AcademyHealth presentation. View the handouts.

The Hilltop Institute’s Director of Medicaid Policy Studies David Idala made a panel presentation entitled Preliminary Findings of an Evaluation of the Maryland Kids First Act: The Use of Tax Forms to Identify Medicaid/SCHIP-Eligible Children at an AcademyHealth Special Interest Group (SIG) Meeting on June 27 in Chicago, Illinois. The presentation, part of the pre-conference proceedings of the AcademyHealth National Research Meeting, was based on an abstract that had been one of 33 high-quality abstracts submitted for peer review. Only two abstracts were chosen for this panel following the rigorous selection process. Idala is the principal investigator of a Robert Wood Johnson Foundation funded State Health Access Reform Evaluation (SHARE) project entitled Evaluating the Success of Maryland’s Kids First Act Outreach at Identifying and Enrolling Uninsured Eligible Children in Medicaid or SCHIP. As a result of the presentation, SHARE has invited Hilltop to collaborate on an issue brief regarding the preliminary findings of the study. To view the presentation, click here.

Anna S. Sommers, PhD, a senior research analyst at The Hilltop Institute, participated on two panels at the AcademyHealth Annual Research meeting in Chicago, Illinois. The first panel occurred at the AcademyHealth State Health Research and Policy Interest Group Meeting, part of the pre-conference proceedings, on June 27 and was entitled Early Results from the State Health Access Reform (SHARE) Program. The second panel, entitled The Lab Reports: Evaluating States’ Actions to Expand Access & Coverage, occurred at the AcademyHealth Annual Research Meeting (ARM) on June 30. At both sessions, Sommers presented the findings from the Hilltop evaluation of small group employer participation in the New Mexico State Coverage Insurance (SCI) program. Sommers and her research team studied the factors that influence small employers’ decisions to participate in SCI, and found policy implications for both states and for federal reform. Policy implications for states are that there is a significant tradeoff between accessing federal dollars and employer recruitment; that some states use standards more transparent to employers; and that reaching the smallest firms may require different strategies. Implications for federal reform are that de-linking federal dollars from Medicaid/CHIP could allow use of more transparent and/or simplified eligibility standards; and that the pay-or-play federal mandate could assist states in engaging larger employers. The evaluation is partially funded by a grant from the Robert Wood Johnson Foundation State Health Access Reform (SHARE) Program. To view the presentation, Click here. To view the handout materials, Click here.