In this issue brief released by the State Health Access Reform Evaluation (SHARE), researchers evaluate New Mexico’s State Coverage Insurance (SCI) program, a public/private partnership that provides access to subsidized health insurance for adults living below 200 percent of the federal poverty level. In particular, the program targets small business owners in New Mexico who may sponsor group enrollment in SCI for their employees.

The authors conducted a survey of SCI enrollees to ask about their employment, employer, prior health insurance coverage, SCI application process, SCI’s affordability, and more. They found that SCI is helping uninsured state residents with low incomes obtain health insurance, and that most of the employed SCI enrollees did not have health insurance in the year prior to enrolling.

With its premium subsidies and public/private collaboration, the authors concluded that SCI may serve as an example of what to expect under the Affordable Care Act (ACA), which aims to encourage small business to offer health insurance through tax cuts and exchange participation. Although they noted that additional variables will come into play once the ACA takes full effect, SCI is one of the few current examples of public/private initiatives to be examined in a post-reform environment. These findings highlight the importance of financial subsidies and size for small businesses and should be considered as ACA implementation moves forward.

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Charles Milligan participated in a meeting for congressional and federal staff hosted by the National Health Policy Forum on October 29, 2010, in Washington, D.C. This meeting, the seventh of the Focus on Reform series providing an in-depth look at various components of the Affordable Care Act (ACA) and related implementation and operational issues, was entitled Medicaid Long-Term Services and Supports (LTSS) Provisions in PPACA. The session provided an overview of the Medicaid LTSS provisions enacted as part of the ACA, including the Community First Choice and Section 1915(i) state plan options; and the balancing incentive payments (BIP) and Money Follows the Person (MFP) programs, among others. Speakers described the provisions; strategies being employed by the Centers for Medicare & Medicaid Services (CMS) to assist states implement the various options, and opportunities and challenges facing states in implementation of the provisions. In his presentation, Milligan discussed the growth in Medicaid expenditures for LTSS; presented the results of a Hilltop study of Medicare/Medicaid cross-payer effects that found that Medicare and Medicaid financing do not align to promote home and community-based services (HCBS); described state and federal opportunities and barriers; and forecasted the take-up of LTSS options in the ACA.

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Charles Milligan participated in a meeting for congressional and federal staff hosted by the National Health Policy Forum on October 29, 2010, in Washington, D.C. This meeting, the seventh of the Focus on Reform series providing an in-depth look at various components of the Affordable Care Act (ACA) and related implementation and operational issues, was entitled Medicaid Long-Term Services and Supports (LTSS) Provisions in PPACA. The session provided an overview of the Medicaid LTSS provisions enacted as part of the ACA, including the Community First Choice and Section 1915(i) state plan options; and the balancing incentive payments (BIP) and Money Follows the Person (MFP) programs, among others. Speakers described the provisions; strategies being employed by the Centers for Medicare & Medicaid Services (CMS) to assist states implement the various options, and opportunities and challenges facing states in implementation of the provisions.

In his presentation, Milligan discussed the growth in Medicaid expenditures for LTSS; presented the results of a Hilltop study of Medicare/Medicaid cross-payer effects that found that Medicare and Medicaid financing do not align to promote home and community-based services (HCBS); described state and federal opportunities and barriers; and forecasted the take-up of LTSS options in the ACA.

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Charles Milligan was one of three experts who spoke at the UMBC Public Policy Forum entitled Health Care Reform: What Will It Mean to Maryland?, held October 22, 2010, in Baltimore, Maryland. In his presentation, entitled What Federal Health Care Reform Legislation Means to States, Milligan gave an overview of the new federal health reform legislation, the Affordable Care Act (ACA), and discussed its implications for states regarding Medicaid; exchanges; insurance-related issues; information technology; long-term services and supports; workforce issues; and preventive services and public health.

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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 first set of metrics, which focuses on institutional utilization and transitions.

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

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Charles Milligan gave this presentation at the closing general session of the American Health Insurance Plans (AHIP) Medicaid Conference on September 16, 2010, in Washington, D.C. The session addressed issues surrounding coordination of coverage and seamless integration of benefits for dually eligible individuals. Milligan’s presentation painted a portrait of dual eligibles, using Maryland as an example; gave an overview of cross-payer effects for dual eligibles and of Hilltop’s research on cross-payer effects for dual eligibles in Maryland; and discussed the study’s findings and policy implications.

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Charles Milligan participated in a roundtable at the 2010 AcademyHealth Research Meeting on June 28, 2010, in Boston, Massachusetts. His presentation gave an overview of Hilltop’s research on cross-payer effects for dual eligibles in Maryland, provided the results of the study, and discussed some implications for policy.

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Harriet L. Komisar participated in a meeting for congressional and federal staff hosted by the National Health Policy Forum on June 18, 2010. This meeting, the third of the Focus on Reform series providing an in-depth look at various components of the Patient Protection and Affordable Care Act (PPACA) and related implementation and operational issues, was entitled <i>Long-Term Services and Supports (LTSS) and the CLASS Act</i>. Komisar&rsquo;s presentation discussed financing sources for LTSS.

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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.

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The Hilltop Institute carried out a resource mapping project for the state of Rhode Island as part of the state’s efforts to create a more accessible system of long-term services and supports under their federal Real Choice Systems Transformation grant. Hilltop interviewed state agency staff on their perceptions of service gaps and barriers to accessing the system of long-term services and supports; conducted a survey of providers of long-term services and supports in the state about current and future capacity to serve Rhode Islanders; and constructed a rebalancing model for projecting utilization and expenditures for Medicaid long-term services and supports through 2030. This report presents the results of these efforts.

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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.