The Hilltop Institute conducted an independent assessment of Salud!, New Mexico’s Medicaid managed care program, to provide an analysis of access to and quality of care for children with persistent asthma and adults with diabetes enrolled in the program. The assessment addressed three policy questions specific to the effectiveness of care delivered to people with chronic disease by the Salud! managed care organizations (MCOs): how does the performance of MCOs in Salud! compare to the performance of other MCOs in the western region of the United States?; have quality of and access to care for people with chronic conditions improved?; and have racial/ethnic and regional disparities in access and quality been reduced? Hilltop researchers found that utilization of primary care and preventive/ambulatory care services among enrollees with chronic conditions is high and that emergency room visits for the conditions studied decreased, demonstrating improvements in both access to and quality of care. To view the New Mexico press release on this report, click here.
This matrix compares managed long-term care programs currently operating in eight states: Arizona, Florida, Massachusetts, Minnesota, New Mexico, New York, Texas, and Wisconsin. The programs were compared based on the following parameters: implementation date; mandatory/voluntary geographic coverage; waiver authority; eligibility; nursing facility (NF) level-of-care required; enrollment; Medicare integration; health plans; covered Medicaid services; risk for NF care; capitation rate methodology; and rate cells.
The Hilltop Institute prepared this resource guide intended for analysts who plan to integrate data on Medicare and Medicaid service use and costs. The Hilltop Crossover Framework is introduced in the guide as an orienting reference device for linked Medicare and Medicaid claims, and is based on a two-by-two format whereby data are arrayed by category of service—with specific reference to Medicaid crossover claims—in order to highlight the relationships between government programs and service use. The term “crossover” refers to Medicaid claims that reflect Medicare patient liability costs that state Medicaid programs cover on behalf of persons eligible under both programs—“dual eligibles” or “duals,” for short. The guide is also intended as a general introduction to Medicare and Medicaid benefits and attendant relationships for analysts who may be less familiar with one or both programs.
Also in this series are: A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data–Poster Presentation, Examining Rate Setting for Medicaid Managed Long-Term Care, Examining the Medicare Resource Use of Dually Eligible Medicaid Recipients, and Cross-Payer Effects on Medicare Resource Use: Lessons for Medicaid Administrators.
Tony Tucker, director of special projects at Hilltop, presented a poster session at the AcademyHealth Annual Research Meeting on June 8 and 9, 2008, on the newly developed Hilltop Crossover Framework, which provides a context to examine the relationship between Medicare and Medicaid claims for dual eligibles. The development of this framework is part of the ongoing process to provide the tools necessary to better coordinate Medicare and Medicaid services for this population.
Also in this series are: A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data, Examining Rate Setting for Medicaid Managed Long-Term Care, Examining the Medicare Resource Use of Dually Eligible Medicaid Recipients, and Cross-Payer Effects on Medicare Resource Use: Lessons for Medicaid Administrators.
States that aim to develop Medicare Advantage Special Needs Plans for dual eligibles may choose from among three potential models discussed in this issue brief: 1) a Medicaid program in which the beneficiary voluntarily enrolls in a single managed care organization (MCO) that delivers both Medicaid and Medicare services; 2) a program in which the beneficiary is required to enroll in a Medicaid MCO but retains freedom of choice regarding whether to enroll in a capitated Medicare plan; and 3) an administrative services organization (ASO) approach, in which Medicaid retains a vendor to coordinate Medicaid services with the SNPs operating in the state. This issue brief also provides guidance on contractual issues important to state Medicaid agencies, and discusses environmental factors that influence the choice of models and the program’s prospects for success.
This report describes the services The Hilltop Institute (as the Center for Health Program Development and Management) provided to the Maryland Department of Health and Mental Hygiene (DHMH) under the Memorandum of Understanding between Hilltop and DHMH. In fiscal year 2007, Hilltop’s interdisciplinary staff provided a wide range of services, including: Medicaid program development and policy analysis; HealthChoice program support, evaluation, and monitoring; behavioral health and dental care analyses; research and analysis related to long-term supports and services; provider fee analyses; managed care payment development and financial monitoring; and data warehousing and website development.
This policy brief, based on research conducted by Dr. Todd Eberly for his dissertation, examines whether a transition from fee-for-service to a managed care Medicaid program improved access to preventive well care services, and whether there were differential effects on service use for racial and ethnic minority youth.
This report describes the services The Hilltop Institute (as the Center for Health Program Development and Management) provided to the Maryland Department of Health and Mental Hygiene (DHMH) under the Memorandum of Understanding between Hilltop and DHMH. In fiscal year 2006, Hilltop’s interdisciplinary staff provided a wide range of services, including: Medicaid program development and policy analysis; HealthChoice program support, evaluation, and monitoring; development of CommunityChoice, Maryland’s managed long-term care program; other research and analysis related to long-term supports and services; managed care payment development and financial monitoring; and data warehousing and website development.
The Hilltop Institute (as the Center for Health Program Development and Management) conducted a telephone survey of 2,100 community-dwelling Maryland Medicaid beneficiaries as the first phase of a broader research agenda to explore how functional status, as measured by activities of daily living (ADLs), is related to resource use over time, as well as how such measures might be used for rate setting and performance assessment for CommunityChoice and other integrated managed long-term care programs.
This report describes the services The Hilltop Institute (as the Center for Health Program Development and Management) provided to the Maryland Department of Health and Mental Hygiene under the 2005 Memorandum of Understanding between Hilltop and the Department. Services included Medicaid program development and policy analysis; HealthChoice program support, evaluation, and monitoring; managed care payment development and financial monitoring; long-term supports and services research and analysis; data warehousing and website development; and analysis of special needs and high-cost populations.