The Hilltop Institute conducted a literature review on pathways to Medicare-Medicaid eligibility at the request of the Medicare-Medicaid Coordination Office (MMCO) within the Centers for Medicare and Medicaid Services (CMS). This work was performed under Task Order RTOP CMS-10-022 awarded to Thomson Reuters (Healthcare), Inc., in 2010.Hilltop also prepared New Medicare-Medicaid Enrollees in Maryland: Demographic and Programmatic Characteristics and New Medicare-Medicaid Enrollees in Maryland: Prior Medicare and Medicaid Resource Use.

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This report, which was presented at the Long-Term Care Interest Group Colloquium at the June 2011 AcademyHealth Annual Research Meeting in Seattle, Washington, discusses progress in rebalancing Medicaid long-term services and supports (LTSS) spending, how the Affordable Care Act can support states’ continued efforts to rebalance LTSS, and opportunities for future research to support continued system transformation.To access the presentation on this topic, click here.

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At the AcademyHealth Annual Research Meeting (ARM), Hilltop Director of Long-Term Services and Supports Cynthia H. Woodcock, MBA, and Maryland Department of Health and Mental Hygiene Deputy Secretary of Finance and former Hilltop Executive Director Charles J. Milligan, Jr., JD, MPH, presented this keynote address at the Long-Term Care Colloquium. Woodcock and Milligan presented highlights from their invited paper focusing on the success, to date, of rebalancing long-term care toward community settings and the implications of provisions in the Affordable Care Act for future rebalancing efforts.To access the invited paper, click here.

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At the AcademyHealth Annual Research Meeting (ARM), Hilltop Senior Policy Analyst Karen E. Johnson, MS, gave this poster presentation, which was also authored by Hilltop Director of Special Research and Development Anthony M. Tucker, PhD, and UMBC Assistant Professor Yi Huang, PhD. The poster described the use of a propensity score matching methodology to identify comparison groups among Medicare-Medicaid beneficiaries who received Medicaid-paid long-term services and supports (LTSS) via home and community-based (HCBS) waivers versus those who did not receive LTSS. This matching technique was used to establish comparable treatment/control pairs for subsequent analysis of cross-payer effects of providing Medicaid-paid LTSS on Medicare acute care resource use, and could be used more generally to strengthen policy analyses that are based on observational and/or administrative data.

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Many of the opportunities made available by the Affordable Care Act (ACA) can be leveraged to work together and to build on existing initiatives. The result can be a strengthened infrastructure for service provision and a long-term services and supports (LTSS) system that can better meet the needs of Medicaid beneficiaries. This National Association of States United for Aging and Disabilities (NASUAD) issue brief, written by Hilltop Director of LTSS Policy and Research Cynthia H. Woodcock, MBA, summarizes key provisions of the ACA and considerations for states seeking to take advantage of these new opportunities.

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Charles Milligan gave a presentation on opportunities to better serve dual eligiles to the Ohio Association of Health Plans and the Ohio Association of Area Agencies on Aging (O4A). He discussed the importance of integrating long-term services and supports for this population; the results of Hilltop’s research on Medicare/Medicaid cross-payer effects for dual eligibles that found that Medicare and Medicaid financing do not align to promote home and community-based services (HCBS) and that the HCBS waiver is only cost-effective (at the individual level) for Medicaid when it truly avoids a nursing home placement; and new opportunities for states under the Affordable Care Act to better serve dual eligibles.

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This presentation, delivered by Charles Milligan to the Medicaid and CHIP Payment and Access Commission (MACPAC) in Washington, D.C., addressed the issue of coordinating long-term care for persons eligible for both Medicare and Medicaid (dual eligibles). Milligan discussed Hilltop’s research on Medicare/Medicaid cross-payer effects that found that Medicare and Medicaid financing do not align to promote home and community-based services.

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With the growing role of home and community-based services (HCBS) in Medicaid long-term services and supports (LTSS), it is important to have a clear understanding of the different characteristics of the population transitioning from institutional care to HCBS, the trends occurring in LTSS over time, and the effect of the different programs. This resulted in Hilltop developing a series of metrics that were first presented to the Maryland Money Follows the Person (MFP) Stakeholder Advisory Group and are now available here in the form of chart books. These metrics can be tailored for any state to guide program development, explore other aspects of its LTSS system (such as opportunities for cost savings and program efficiency), and target populations for outreach efforts. This chart book discusses the third set of metrics, which focuses on the service use and costs of transitioned individuals.

Also in this series are: Institutional Utilization and Transitions,The Institutional Characteristics of Transitioned Individuals, The Quality of Life Survey Responses, and a Summary.

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This series of chart books, entitled Medicaid Long-Term Supports and Services in Maryland, summarizes demographic, service utilization, and expenditure data for state fiscal years 2006 through 2009 on four Maryland Medicaid waiver programs—the Older Adults Waiver, the Living at Home Waiver, the Autism Waiver, and the Medical Day Care Services Waiver—and on nursing facility utilization among Maryland Medicaid recipients. These chart books, prepared for the Maryland Department of Health and Mental Hygiene, are intended to monitor trends in these programs. Hilltop updates the chart books annually. The Medical Day Care Services Waiver Chart Book provides information on Maryland Medicaid participants who receive services through this program, which provides health, social, and related support services to individuals aged 16 years and older who reside in the community and meet a nursing facility level of care. Services are provided through approved medical day care agencies.

Also in this series are: The Nursing Facilities Chart Book, The Older Adults Waiver Chart Book, The Living at Home Waiver Chart Book, and The Autism Waiver Chart Book.

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This series of chart books, entitled Medicaid Long-Term Supports and Services in Maryland, summarizes demographic, service utilization, and expenditure data for state fiscal years 2006 through 2009 on four Maryland Medicaid waiver programs—the Older Adults Waiver, the Living at Home Waiver, the Autism Waiver, and the Medical Day Care Services Waiver—and on nursing facility utilization among Maryland Medicaid recipients. These chart books, prepared for the Maryland Department of Health and Mental Hygiene, are intended to monitor trends in these programs. Hilltop updates the chart books annually. The Autism Waiver Chart Book provides information on Maryland Medicaid participants who receive services through this program, which provides home and community-based services to children from the age of 1 year through the end of the school year in which the child turns 21. The Autism Waiver is administered by the Maryland State Department of Education.

Also in this series are: The Nursing Facilities Chart Book, The Older Adults Waiver Chart Book, The Living at Home Waiver Chart Book, and The Medical Day Care Services Waiver Chart Book.

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