This chart book is the fifth in a series that explores service utilization and expenditures for Medicaid-funded long-term services and supports in Maryland. The focus of this chart book is on Medicaid HCBS, with one chapter dedicated to illustrating Maryland’s efforts at providing these services to an increasing number of Medicaid recipients who may otherwise be served in institutions.

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This chart book is the sixth in a series that explores utilization and expenditures for Medicaid‐funded LTSS in Maryland for fiscal years (FYs) 2012 through 2016. 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.

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Hilltop staff presented at the 2019 AcademyHealth Annual Research Meeting (ARM). On June 3, Senior Director of Analytics and Research and Chief Data Scientist Ian Stockwell, PhD, presented this poster, which summarizes the work he led to identify factors found in clinical and functional assessment tools that increase the risk of a future nursing home (NH) admission and apply those risk-scoring coefficients to individuals on Maryland’s Home and Community-Based Services (HCBS) waiting list.

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As part of its participation in the Maryland Primary Care Program (MDPCP), The Hilltop Institute is developing a risk model that will score primary care patients attributed to MDPCP-participating practices according to risk of avoidable hospitalization and/or emergency department (ED) utilization. These patient-level risk scores will ultimately be vended to participating medical practices on a monthly basis in order to facilitate care management through the improved allocation of scarce care coordination resources.

As a first step in this process, Hilltop conducted a comprehensive literature review. The goal of the review was to find peer-reviewed academic journal articles that identify risk factors for potentially avoidable hospitalization, thus providing a basis for risk factor extraction and risk model feature creation. Identified risk factors will be coded using CCLF and other publicly available data sources and included in the final risk model as potential predictors of avoidable hospitalization or ED use. The literature review provides the foundation for the MDPCP risk model and is a crucial step in the modeling process.

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This report describes the services The Hilltop Institute provided to the Maryland Department of Health (the Department) under the Master Agreement between Hilltop and the Department. The report covers fiscal year (FY) 2018 (July 1, 2017, through June 30, 2018). Hilltop’s interdisciplinary staff provided a wide range of services, including: Medicaid program development and policy analysis; HealthChoice program support, evaluation, and financial analysis; long-term services and supports program development, policy analysis, and financial analytics; and data management and web-accessible database development.

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Hilltop staff presented at the 2018 AcademyHealth Annual Research Meeting (ARM) in Seattle in June. Policy Analyst MaryAnn Mood, MA, presented this poster about Hilltop’s study regarding the gradual implementation of Community First Choice (CFC) in Maryland. CFC is an optional Medicaid state plan program authorized by the Affordable Care Act (ACA) that enables states to provide home and community-based services (HCBS) to Medicaid-eligible individuals through their state plan and receive a 6 percent increase in their federal match.

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This issue brief, published by the Commonwealth Fund, analyzes trends in paid and unpaid personal care and expenditures under a model Medicaid Community First Choice (CFC) program in Maryland. This brief highlights enrollment trends and costs per participant and concludes that a targeted benefit for Medicare beneficiaries could have a stable per-person cost and augment support from family and other unpaid caregivers, although take-up could increase over time to meet unmet need. Hilltop’s Cynthia Woodcock, Ian Stockwell, and Kaitlyn Whiton were contributing authors.

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The authors of this article, published by the Journal of Applied Gerontology, interviewed stakeholders in Maryland, one of the first states to adopt CFC, to assess challenges, benefits, and potential implications of this Medicaid option for state and federal policy makers. Study findings suggest that expanding coverage for home and community-based services (HCBS) through CFC in Maryland has been financially feasible, expanded the personal care workforce, and supported a more equitable approach to personal care services. The article concludes that greater coverage for HCBS is a promising avenue to improve access to care for high-need Medicaid beneficiaries. Hilltop’s Cynthia Woodcock and Ian Stockwell were contributing authors.

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Hilltop Senior Policy Analyst Charles Betley, MA, is a co-author of this top-cited article published in the journal Population Health Management. The article presents the findings of a study, funded by a grant from the Robert Wood Johnson Foundation, which sought to examine whether Supplemental Nutrition Assistance Program (SNAP) participation and benefit levels are associated with reduced subsequent hospital and emergency department utilization in low-income older adults who are eligible for both Medicare and Medicaid (dual eligibles). Researchers found that while participation in SNAP did reduce hospitalizations, it did not reduce ED visits. The research team is a collaboration led by Benefits Data Trust (BDT) including BDT, Hilltop, the Johns Hopkins Schools of Nursing and Public Health, and Northwestern University. Organizational partners include the Maryland Departments of Health and Human Resources.

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Hilltop Senior Policy Analyst Charles Betley, MA, is a co-author of this article published in the journal BMC Geriatrics. The article presents the findings of a study, funded by a grant from the Robert Wood Johnson Foundation, which sought to examine whether Supplemental Nutrition Assistance Program (SNAP) participation and benefit levels are associated with reduced subsequent hospital and emergency department utilization in low-income older adults who are eligible for both Medicare and Medicaid (dual eligibles). Researchers found that while participation in SNAP did reduce hospitalizations, it did not reduce ED visits. The research team is a collaboration led by Benefits Data Trust (BDT) including BDT, Hilltop, the Johns Hopkins Schools of Nursing and Public Health, and Northwestern University. Organizational partners include the Maryland Departments of Health and Human Resources.

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Hilltop continues to work remotely, so please reach us by email. You can find our team members’ email addresses by going to their bios located on the Teams page of our website.