Comprehensive assessments play an important role as states seek to provide more long-term care (LTC) in home and community-based service (HCBS) settings rather than in institutions. A well-designed assessment instrument identifies the full range of a consumer’s service needs so that they can be addressed, thus preventing or delaying the need for institutionalization. This report identifies trends and emerging best practices in comprehensive assessments for HCBS. Assessment instruments from 13 states are included in the analysis.
This presentation to the federal Medicaid Commission on September 6, 2006, discusses Medicaid reimbursement for private providers, safety-net providers, public providers, and managed care organizations.
This presentation to the federal Medicaid Commission on September 6, 2006, addresses the Medicaid federal-state funding match, oversight to detect fraud and abuse, workforce issues that may impact Medicaid reform strategies, and the flexibility offered by Medicaid waivers.
This report provides an update on the overall performance of HealthChoice, Maryland’s Medicaid managed care program, regarding access and utilization for select populations. The update focuses on HealthChoice performance for calendar years (CYs) 2003 through 2007.
The Hilltop Institute conducted an independent assessment of Salud!, New Mexico’s Medicaid managed care program, to provide an analysis of access to and quality of care for children with persistent asthma and adults with diabetes enrolled in the program. The assessment addressed three policy questions specific to the effectiveness of care delivered to people with chronic disease by the Salud! managed care organizations (MCOs): how does the performance of MCOs in Salud! compare to the performance of other MCOs in the western region of the United States?; have quality of and access to care for people with chronic conditions improved?; and have racial/ethnic and regional disparities in access and quality been reduced? Hilltop researchers found that utilization of primary care and preventive/ambulatory care services among enrollees with chronic conditions is high and that emergency room visits for the conditions studied decreased, demonstrating improvements in both access to and quality of care. To view the New Mexico press release on this report, click here.
To follow up on a previous study, Hilltop surveyed the literature to understand the current status of legislation among states regarding academic detailing/prescriber education (AD), as well as to describe existing efforts. AD programs are established for a variety of reasons but generally prioritize a target population based on age, gender, or geographic location; drug/drug class; disease entity; or a combination of these factors.
The Hilltop Institute, in collaboration with the Center for the Study of Democracy at St. Mary’s College of Maryland, conducted a study of potential processes for improving eligibility and enrollment procedures through linkages with other sources, including, but not limited to, enrollment in other public service programs such as the Supplemental Nutrition Assistance Program (SNAP), the National School Lunch Program (NSLP), and Temporary Assistance for Needy Families (TANF). Researchers also analyzed the two most typical approaches states use to maximize linking program eligibility processes and data between Medicaid/SCHIP and other existing public programs: a unified application procedure to determine eligibility for multiple programs, and accessing existing data from other public programs to identify potentially uninsured children participating in those programs. The report concludes with options for Maryland.
This matrix compares managed long-term care programs currently operating in eight states: Arizona, Florida, Massachusetts, Minnesota, New Mexico, New York, Texas, and Wisconsin. The programs were compared based on the following parameters: implementation date; mandatory/voluntary geographic coverage; waiver authority; eligibility; nursing facility (NF) level-of-care required; enrollment; Medicare integration; health plans; covered Medicaid services; risk for NF care; capitation rate methodology; and rate cells.
The Maryland Department of Health and Mental Hygiene (DHMH), on behalf of Maryland’s Money Follows the Person (MFP) demonstration, requested that The Hilltop Institute conduct a study to provide a better understanding of service utilization by Medicaid beneficiaries with traumatic brain injury (TBI) who reside in nursing facilities. This study examined nursing facility service utilization and costs for individuals with a diagnosis of TBI, anoxia, or both TBI and anoxia. Hilltop concluded that for Maryland’s MFP demonstration to succeed in its goal of transitioning persons with brain injury from institutional settings to the community, it will be important to ensure that appropriate community-based mental health services, occupational/physical/speech therapies, and durable medical equipment are available to this population. In addition, because psychotropic medication utilization is significant among this population, medication use must be carefully managed and monitored.
The Hilltop Institute’s Director of Long-Term Supports and Services, Cynthia H. Woodcock, and Manager of Health Services Research, Al Adamson, presented a workshop on September 29, 2008 in Boston at The Spirit of Independence: 24th National Home and Community Based Services Conference convened by the National Association of State Units on Aging. In the workshop, entitled A Methodology for Projecting a State’s Long-Term Care Costs, they discussed the methodology that Hilltop developed to project long-term care costs in Maryland for 2010, 2020, and 2030, how other states could use that methodology to project future spending, and offered guidelines on how states could facilitate change in their long-term care systems.
