Aging & Disability

One goal of a healthy society is to enable persons who are aging or have a disability to live in their own homes or other community settings rather than in institutions. For more than 15 years, Hilltop has provided consultation to states on rebalancing health care delivery and financing systems from a focus on institutional care to home and community-based services and supports. We have assisted states in designing Medicaid §1915(b)(c), §1915(c), and §1115 waiver programs for people with chronic conditions and disabilities, including a managed long-term services and support (LTSS) program for the state of New Mexico that was later absorbed into a comprehensive §1115 waiver program. We were engaged in projects to transform or evaluate LTSS systems in New Jersey and Rhode Island as well. For Maryland, Hilltop coordinated the development, testing, and implementation of LTSSMaryland, a web-based information system with functional assessments, plans of care, and program enrollment information for Medicaid beneficiaries receiving LTSS. We also consulted with the state of Mississippi on the development of LTSSMississippi.

For Maryland Medicaid and the Developmental Disabilities Administration (DDA), Hilltop analyzed the final rule issued by the Centers for Medicare & Medicaid Services (CMS) on what qualifies as a home and community-based setting for 1915(c) ad 1915(k) waiver programs. To assess compliance, we developed and administered two provider surveys for the state.

Maryland’s Community First Choice (CFC) program, authorized under §2401 of the Affordable Care Act and implemented in January 2014, offers community-based services as a Medicaid state plan benefit to individuals who are assessed to need an institutional level of care. Hilltop conducts analyses of CFC to determine cost neutrality, assess cost effectiveness and service utilization, and monitor and refine the flexible budgeting methodology.

Featured Work

Expenditures by Service Pie Chart

Lessons from Maryland’s Community First Choice Program

In collaboration with the Johns Hopkins Bloomberg School of Public Health, Hilltop examined CFC development and service utilization in Maryland during the program’s first three years. Findings are published in a Commonwealth Fund issue brief and will be published in the Journal of Applied Gerontology.

Burgdorf J, Wolff JL, Willink A, Woodcock C, Davis K, Stockwell I. Expanding Medicaid Coverage for Community-Based Long-Term Services and Supports: Lessons from Maryland’s Community First Choice Program.  Journal of Applied Gerontology; in press.

Findings from Hilltop’s analysis are also published in a Hilltop data brief.

Number of Individuals on the Autism Waiver Registry List, by Age Group, FY 2016

Medicaid LTSS Chart Books

Hilltop publishes a series of chart books on the provision of LTSS to Medicaid beneficiaries.

Medicaid Long-Term Services and Supports in Maryland Series: FY 2012 to FY 2016

Volume 1, The Autism Waiver. A Chart Book. Abridged.
Volume 2, The Brain Injury Waiver. A Chart Book. Abridged.
Volume 3, Medical Day Care Waiver. A Chart Book. Abridged.
Volume 4, The Model Waiver. A Chart Book. Abridged.

Staff Expert

Stephanie Cannon-Jones

Stephanie Cannon-Jones

Senior Policy Analyst