HealthChoice—Maryland’s statewide mandatory Medicaid managed care program—was implemented in 1997 under authority of Section 1115 of the Social Security Act. Since the inception of HealthChoice, the Maryland Department of Health has conducted five comprehensive evaluations of the program as part of the 1115 waiver renewals. Between waiver renewals, the Department completes an annual evaluation for HealthChoice stakeholders. This report is the 2014 annual evaluation of the HealthChoice program.
On March 29, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule on Medicaid and Children’s Health Insurance Programs; Mental Health Parity and Addiction Equity Act of 2008; the Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care Organizations (MCOs), the Children’s Health Insurance Program (CHIP), and Alternative Benefit Plans (ABPs) (https://www.gpo.gov/fdsys/pkg/FR-2016-03-30/pdf/2016-06876.pdf). This rule provides new requirements for Medicaid and CHIP compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equality Act of 2008 (MHPAEA) and the Affordable Care Act (ACA). Final MHPAEA regulations for group health insurance plans were issued in 2013. Much of this final rule extends the MHPAEA requirements for group health plans to Medicaid MCOs, CHIP, and ABPs, with exceptions and changes as applicable to address the unique aspects of state Medicaid mental health (MH) and substance use disorder (SUD) delivery systems. This document provides a high-level summary of the rule and highlights the changes to the proposed rule.
HealthChoice—Maryland’s statewide mandatory Medicaid managed care program—was implemented in 1997 under authority of Section 1115 of the Social Security Act. Since the inception of HealthChoice, the Maryland Department of Health has conducted five comprehensive evaluations of the program as part of the 1115 waiver renewals. Between waiver renewals, the Department completes an annual evaluation for HealthChoice stakeholders. This report is the 2013 annual evaluation of the HealthChoice program.
HealthChoice—Maryland’s statewide mandatory Medicaid managed care program—was implemented in 1997 under authority of Section 1115 of the Social Security Act. Since the inception of HealthChoice, the Maryland Department of Health has conducted five comprehensive evaluations of the program as part of the 1115 waiver renewals. Between waiver renewals, the Department completes an annual evaluation for HealthChoice stakeholders. This report is the 2012 annual evaluation of the HealthChoice program.
HealthChoice, Maryland’s statewide mandatory Medicaid managed care program, was implemented in 1997 under authority of Section 1115 of the Social Security Act. The HealthChoice managed care program currently enrolls over 80 percent of the state’s Medicaid population. The program also enrolls children in the Maryland Children’s Health Program (MCHP), Maryland’s Children’s Health Insurance Program (CHIP). Since the program’s inception, the Maryland Department of Health has conducted four comprehensive evaluations as part of the 1115 waiver renewals. Between waiver renewals, the Department continually monitors HealthChoice performance on a variety of measures and completes an annual evaluation for HealthChoice stakeholders. This report is the 2011 annual evaluation of the HealthChoice program.
This report is the fourth and final report in a series that explores the cross-payer effects of providing Medicaid long-term supports and services (LTSS) on Medicare acute care resource use. The report provides a summary of the initial work of a study, described more fully in the first three reports, with an emphasis on lessons that state Medicaid administrators should consider as they move toward more formal programs of integrated care for persons dually eligible for Medicare and Medicaid (or duals, for short).
Also in this series are: A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data, A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data–Poster Presentation, Examining Rate Setting for Medicaid Managed Long-Term Care, and Examining the Medicare Resource Use of Dually Eligible Medicaid Recipients.
This report is the third in a series that explores the cross-payer effects of providing Medicaid long-term supports and services (LTSS) on Medicare acute care resource use. The report reflects an exploratory analysis of the relationships between Medicare resource use and Medicaid long-term supports and services to address the question: Does providing Medicaid LTSS influence dually eligible Medicaid recipients’ use of Medicare resources and, if so, how and to what extent? Report results suggest two general aspects of these effects: (1) Medicaid LTSS provided in the community are associated with an increase in the number of Medicare services used with no, or limited, additional Medicare costs overall, and (2) Medicaid institutional supports offset Medicare resource use overall. Analytic methods, including propensity score matching techniques used to conduct this analysis, are also highlighted in the report. Much like the first two reports, this report is intended to provide general background information on the interplay of Medicare and Medicaid resources using data from one state—Maryland—as an example for analysts who are beginning to examine similar issues at the state and federal levels.
Also in this series are: A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data, A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data–Poster Presentation, Examining Rate Setting for Medicaid Managed Long-Term Care, and Cross-Payer Effects on Medicare Resource Use: Lessons for Medicaid Administrators.
This report 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 might be used to set rates for Medicaid capitation payments for managed long-term care. The report examines, in further detail, the overall patterns of resource use, and presents and simulates a rate setting system to cover the Medicaid portion of costs associated with coordinated care in an integrated Medicare and Medicaid environment. The relationship between CMS Hierarchical Condition Categories-based risk adjustment that is used to establish payments for Medicare Advantage plans and Medicaid resource use is also explored.
Also in this series are: A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data, A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data–Poster Presentation, Examining the Medicare Resource Use of Dually Eligible Medicaid Recipients, and Cross-Payer Effects on Medicare Resource Use: Lessons for Medicaid Administrators.
This presentation to the federal Medicaid Commission on September 6, 2006, discusses Medicaid reimbursement for private providers, safety-net providers, public providers, and managed care organizations.
This report provides an update on the overall performance of HealthChoice, Maryland’s Medicaid managed care program, regarding access and utilization for select populations. The update focuses on HealthChoice performance for calendar years (CYs) 2003 through 2007.