The Hilltop Institute prepared a report on Medicaid Non-Emergency Medical Transportation (NEMT) in Maryland on behalf of the Maryland Department of Health and Mental Hygiene. House Bill 235, passed in the 2008 legislative session, mandated a study on the creation of a uniform statewide NEMT program, with findings to be reported to the legislature by October 1, 2008. Hilltop conducted the study, which evaluated the feasibility of creating a uniform statewide NEMT program in Maryland; any potential cost savings or potential for quality improvement; and the potential impact of the creation of such a program on local health departments. To conduct the study, Hilltop surveyed local jurisdictions and state administrators of NEMT programs across the country, and assured stakeholder involvement by presenting the study design and incorporating comments gathered at an NEMT stakeholder’s meeting, the Medicaid Advisory Committee, and the Money Follows the Person Committee.
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.
This report describes the services The Hilltop Institute provided to the Maryland Department of Health and Mental Hygiene (DHMH) under the 2008 Memorandum of Understanding between Hilltop and DHMH. The report covers state fiscal year 2008 (July 1, 2007, through June 30, 2008). Hilltop’s interdisciplinary staff provided a wide range of services, including: Medicaid acute care program development and policy analysis; HealthChoice program support, evaluation, and monitoring; behavioral health and dental care analyses; research, analysis, and program development related to long-term supports and services; Medicaid rate setting–payment development and financial monitoring; and data management and web-accessible database development.
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.
This study, in response to the mandate of Maryland House Bill 594, analyzes Maryland’s options to increase access to long-term services, including home- and community-based services (HCBSs) such as adult medical day care, for individuals at high risk of institutionalization because of cognitive impairments, mental illness, traumatic brain injury, or other conditions, who met financial eligibility criteria in effect as of June 1, 2007. Three approaches to expand access to Medicaid HCBS were considered: Maryland could lower its nursing facility (NF) level of care (LOC) criteria to ease entry into both NFs and community-based programs; Maryland could leave its NF LOC at its current standard, but expand access to HCBS by providing enough funds to move people from the registries for the Older Adult Waiver (OAW) and Living at Home (LAH) waiver into services; or Maryland could adopt the new authority, included in the recently enacted federal Deficit Reduction Act (DRA), to create a service package of HCBS without the need for a waiver. The Hilltop Institute (as the Center for Health Program Development and Management) reviewed Maryland and seven other states and the District of Columbia, analyzed the estimated costs and effects of three approaches mentioned above, and analyzed the potential for long-term savings for a state, should it elect to lower its NF LOC.
The Special Needs Plan (SNP) is a new type of Medicare Advantage plan created by the Medicare Modernization Act of 2003 (MMA). The plans target one of three special needs populations, including dual eligibles. This issue brief identifies the key issues that underlie one of the MMA’s central goals for dual-eligible SNPs—”the potential to offer the full array of Medicare and Medicaid benefits, and supplemental benefits, through a single plan”—and outlines their progress thus far. The brief observes that true coordination between SNPs and Medicaid programs, despite some state and federal initiatives, has largely failed to occur, and it discusses some of the reasons why. Consequently, the brief offers recommendations for improving dual-eligible SNPs’ prospects and extending their lives (legal authorization for SNPs is scheduled to expire at year-end 2008).
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.
The Hilltop Institute (as the Center for Health Program Development and Management) prepared this report on behalf of the Maryland Health Care Commission and in collaboration with the Center for Social Science Research at George Mason University. Required by the Long-Term Care Planning Act of 2006 (House Bill 1342), the report examines the long-term care needs and costs for individuals aged 65 and older and persons with disabilities in 2010, 2020, and 2030. Total costs to the state for long-term supports and services are projected to increase more than threefold from 2005 to 2030 ($1.99 billion to $6.06 billion). The report concludes that planning must begin now or the state’s existing system for the provision of long-term supports and services is likely to be overwhelmed by the aging baby boomers and anticipated trends in the prevalence and intensity of disability.
On behalf of the Maryland Community Health Resources Commission, The Hilltop Institute (as the Center for Health Program Development and Management) conducted a study of funding and access issues that have an impact on the financial viability and continued growth of Maryland’s school-based health centers (SBHCs). The legislation establishing the Commission—the Community Health Care Access and Safety Net Act of 2005—required that the study be carried out. The study examined SBHC financing, assessed barriers to reimbursement, and recommended directions the Commission might pursue to expand access to SBHCs, promote increased reimbursement, and further develop the infrastructure and stabilize the financing of SBHCs.
This issue brief examines marketing and enrollment strategies in four states that have implemented coverage initiatives. It attempts to draw some conclusions on “best practices.” The Hilltop Institute (as the Center for Health Program Development and Management) conducted telephone interviews with state officials and health insurance agents and brokers from
Arizona, Montana, New Mexico, and Oklahoma to elicit information about the relative success of
various marketing strategies.