Health Care Access & Affordability

Hilltop works to find innovative strategies for expanding access to affordable health care coverage and services with the goal of empowering consumers.

Maryland is 1 of 13 states that operate their own health insurance marketplace. Since the passage of the Affordable Care Act in 2010, Hilltop has performed data analytics and policy analysis to the Maryland Health Benefit Exchange (MHBE), the entity responsible for Maryland Health Connection, the state’s marketplace. Issues examined include continuity of care, value-based insurance design, provider network standards, and strategies for market stabilization.

Hilltop modeled several options for a state reinsurance program for the MHBE, informing deliberations for HB 1795, Maryland Health Benefit Exchange-Establishment of a Reinsurance Program, which was signed by Governor Larry Hogan on April 5, 2018. The legislation authorized the reinsurance program and directed the MHBE to apply for a §1332 waiver from the federal government. This waiver was required to implement Maryland’s program. To fund the reinsurance program, the Governor signed HB 1782 on April 10, 2018, which authorized the state to collect the 2019 federal health insurance provider tax that the federal government had suspended. Hilltop assisted with the §1332 waiver application, staffed the required public hearings, and compiled and synthesized public comments. CMS approved the waiver and the state reinsurance program was established. Prior to approval of the reinsurance program, insurers requested an average rate increase of 30 percent; since reinsurance, the MIA has approved rates with a cumulative impact of a rate decrease of more than 22 percent versus 2018 premiums.

For Maryland Medicaid, Hilltop conducts the annual evaluation of the HealthChoice program, Maryland’s managed care program that serves 1.1 million individuals with capitation payments totaling almost $6 billion annually. We also examine service utilization, costs, and outcomes for special programs or populations, such as the Community Health Pilots for home visiting services and assistance with community integration.

Under Maryland’s all-payer global budget model for hospitals, the state must monitor total cost of care by payer. Hilltop developed a methodology for calculating and monitoring Medicaid total cost of care that is being used by the Health Services Cost Review Commission to guide total cost of care calculations for other payers.

Featured Work

Healthcare Relative Cost Graphic

To compare what commercial insurers paid for health care in Maryland against four other regions across the country, Hilltop partnered with the Maryland Health Care Commission in an initiative led by the Network for Regional Healthcare Improvement (NRHI). The study used a standard measure of costs from HealthPartners of Minnesota and required Hilltop to analyze 2014 data from Maryland’s all payer claims database. NRHI recently published an updated report using 2015 data. Maryland was consistently the lowest cost of the five regions studied.

Illustration of Dentist's Office

In 2016, Hilltop examined the cost and policy implications of expanding adult dental coverage under Maryland Medicaid. This analysis informed the Maryland Medical Assistance Program Dental Coverage for Adults Pilot Program (Senate Bill 284) passed by the Maryland General Assembly during the 2018 legislative session and signed by Governor Larry Hogan on May 15, 2018.

Staff Expert

Laura Spicer

Laura Spicer

Director, Health Reform Studies


David Idala

David Idala

Director, Medicaid Policy Studies