This chart book explores utilization and expenditures for Medicaid-funded LTSS in Maryland for state fiscal year (FY) 2019 through FY 2023. The focus of this chart book is on Medicaid nursing facility services, with one chapter that illustrates Maryland’s efforts at providing home and community-based services (HCBS) to an increasing number of Medicaid recipients who may otherwise be served in nursing facilities.
The Hilltop Institute has released updated analysis of the Medicaid provider tax provisions of the Senate budget reconciliation bill. The estimates, which model the version of the bill released from the Senate Finance committee on June 16, 2025, update Hilltop’s earlier analysis of provider taxes. Authored by Hilltop Director of Analytics & Research Dr. Morgan Henderson, Senior Data Scientist Dr. Leigh Goetschius, and Executive Director Alice Middleton, this analysis uses hospital provider tax rates and net patient revenue data to calculate the estimated state-level impacts of the proposed Senate legislation. The authors find that, once the provider tax reductions are fully implemented as of 2031, this legislation would reduce federal funding to 18 Medicaid expansion states by over $11.9 billion annually. Moreover, the impact will not be uniform: the impact will be largest in states with high hospital provider tax rates. Specifically, the authors find that Arizona, New Hampshire, Nevada, Iowa, Vermont, and Michigan would each at lose least 7.5% of their federal Medicaid funding as a result of this bill.
While the proposed legislation proposes a suite of Medicaid policy changes that would interact in various ways, this analysis only considers the hospital provider tax change in isolation. This is the latest in a series of Hilltop analyses focused on modeling state-level impacts of potential federal Medicaid policy changes.
Principal Policy Analyst Christine Gill, PhD, presented this poster at the 2025 AcademyHealth Annual Research Meeting (ARM) held June 7–9 in Minneapolis.
This document, written by Hilltop Director of Analytics & Research Morgan Henderson, Senior Data Scientist Leigh Goetschius, and Interim Executive Director Alice Middleton, quantifies the impact of removing the 6% provider tax safe harbor threshold on state-level federal Medicaid funding. Using data on hospital and nursing facility tax rates and net patient revenue, this analysis finds that eliminating the 6% provider tax threshold for hospitals and nursing facilities would put $83.7 billion of federal Medicaid funding at risk.
This one-pager, written by Hilltop Director of Analytics & Research Morgan Henderson, Senior Data Scientist Leigh Goetschius, Director of Aging & Disability Studies Christin Diehl, and Interim Executive Director Alice Middleton, quantifies the impact of removing the 50% Medicaid Federal Medical Assistance Percentage (FMAP) floor on federal spending on Medicaid-funded home and community-based intellectual and developmental disabilities (ID/DD) services in states. The one-pager estimates the federal funding decreases overall and for each of the ten states that would be the most impacted.
This one-pager, written by Hilltop Director of Analytics & Research Morgan Henderson, Senior Data Scientist Leigh Goetschius, and Interim Executive Director Alice Middleton, quantifies the impact of removing the 50% Medicaid Federal Medical Assistance Percentage (FMAP) floor on the federal Medicaid funding to states. The one-pager estimates the federal funding decreases overall and for each of the ten states that would be the most impacted.
Hilltop Director of Analytics & Research Morgan Henderson, Senior Director of Health Reform Studies Laura Spicer, and Interim Executive Director Alice Middleton discuss their re-examination of 2018-2019 enrollment data from Arkansas Works (the state’s Medicaid work requirement program) in this article published in the Health Affairs Forefront series.
The Assistance in Community Integration Services (ACIS) pilot program began in late 2017 with the goal of reducing unnecessary health services use among Medicaid beneficiaries by providing tenancy and housing case management services through four lead entities (LEs). This infographic provides a brief overview of Hilltop’s 2022 review of the pilot program.
Hilltop Policy Analyst Advanced Roberto Millar, PhD, and Director of Aging and Disability Studies Christin Diehl coauthored this article published in Nursing Reports. This article discusses the results of a cross-sectional study that utilizes public data from 218 Medicare and Medicaid-certified nursing facilities in Maryland to examine the association between staffing requirements and quality of care ratings, as well as the role facility ownership plays.
Hilltop Policy Analyst Advanced Roberto Millar, PhD, and Director of Aging and Disability Studies Christin Diehl coauthored this article published in the Journal of Applied Gerontology. They discuss the importance of nursing facility structural characteristics in contributing to residents’ quality of care. The study used data from 220 Maryland nursing facilities to examine associations between two different quality-of-care metrics: family satisfaction and Care Compare five-star quality ratings.