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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Charles Milligan was the luncheon keynote speaker for the University of Illinois Institute of Governmental and Public Affairs (IGPA) State Summit 2010: Reforming Medicaid in Illinois on December 7, 2010, in Champaign, Illinois. Milligan’s keynote address discussed economic trends and Medicaid; health reform; budget tools; and the changing state/federal relationship. This presentation deals with national trends and could be helpful to all states as they struggle with ensuring access to health services in a difficult economic environment.

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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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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 Living at Home Waiver Chart Book provides information on Maryland Medicaid participants who receive services through this program, which provides community-based services and supports for low-income individuals with physical disabilities who are aged 18 to 64 years at the time of enrollment, and who would otherwise require the services of a nursing facility. The Living at Home Waiver is administered by Maryland Medicaid.

Also in this series are: The Nursing Facilities Chart Book, The Older Adults Waiver Chart Book, The Autism Waiver Chart Book, and The Medical Day Care Services 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 Older Adults Waiver Chart Book provides information on Maryland Medicaid participants who receive services through this program, which enables low-income individuals aged 50 years and older to remain in a community setting even though, because of their health status, they are eligible for placement in a long-term care facility. The Older Adults Waiver is administered by the Maryland Department of Aging.

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

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This Health Services Research article, published online in December 2010 and in print in January 2011, presents the findings of a Hilltop research project that identified factors associated with small group employer participation in New Mexico’s State Coverage Insurance (SCI) program. This article discusses administrative and cost issues that small employers considered when deciding whether to participate in the SCI program. It concludes that administrative and cost barriers to participation in SCI reported by employers suggest that the tax credit offered to small businesses under new federal provisions, which merely offsets the employer portion of premium, could be more effective if accompanied by additional supports to businesses. The study was partially funded by a grant to Hilltop and its partner, the New Mexico Human Services Department, from the Robert Wood Johnson Foundation State Health Access Reform Evaluation (SHARE).

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Hilltop Director of Clinical and Quality Management Annette Snyder, PhD, delivered this presentation at the 138th American Public Health Association (APHA) Annual Meeting held November 6 through 10, 2010, in Denver, Colorado. The Impact of Selected Demographic, Mental Health, and Geographic Measures on Discharge from Nursing Homes among Working-Age Adults in Maryland discusses a study that examined factors associated with discharge to the community for working-age adults admitted to Maryland nursing homes over a five-year period. The study found that the strongest factors related to discharge to the community were an individual’s expressed preference for discharge and perceived support for community discharge.

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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 second set of metrics, which focuses on the institutional characteristics of transitioned individuals.

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

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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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