State/Agency Information

This report presents the Medicaid Commission's recommendations for the long-term sustainability of the Medicaid program. Review the recommendations about Long-Term Care, Benefits Design, Eligibility, Health Information Technology, Quality and Care Coordination. The Commission strongly recommends increased state flexibility in many areas to tackle more locally influenced issues.

The Maryland General Assembly passed the Long-Term Care Planning Act of 2006, which requires the Maryland Health Care Commission to conduct a study of Maryland’s long-term care delivery system. The purpose of the study is to determine the types of services and programs that individuals aged 65 and older and individuals with disabilities will need in 2010, 2020, and 2030, as well to identify how the State should begin planning for future needs. This report presents the results of the study.

This report discusses the options for expanding home and community based services in the state of Maryland as required by Bill 594. Should Maryland elect to expand access to Medicaid home- and community-based services(HCBS), it has several possible approaches. This report discusses these options for Maryland in detail; ideas other states designing similar programs might find useful.

This article outlines three potential models which may be adopted by states looking to develop programs designed to serve those individuals who are dually eligible for Medicare and Medicaid benefits. The article also discusses possible contractual issues important to state Medicaid agencies as well as environmental factors which may influence the choice of models and potential program's prospects for success.

Check to ensure that your providers are eligible to receive Medicaid funds. Bases for exclusion include convictions for program-related fraud and patient abuse, licensing board actions and default on Health Education Assistance Loans. States cannot be reimbursed with Federal Medicaid dollars for any item or service furnished, ordered, or prescribed by individuals or entities on this list. Further, no payment will be made for services or products from providers that employ someone on this list.

CMS offers guidance to states on how to avoid payments to excluded entities and the consequences of failing to prevent these payments. The letter stresses that it is the states’ responsibility to clearly communicate to providers that it is their obligation to screen employees and contractors for exclusion prior to hiring or contracting. It also provides the location of the List of Excluded Individuals/Entities which can be used to prevent improper payment.

This issue brief focuses on the special needs population of dual eligible’s as defined in the Special Needs Plan (SNP), a type of Medicare Advantage plan created by the Medicare Modernization Act of 2003 (MMA). The brief concludes how the SNP has failed this population and offers recommendations for improving dual-eligible SNPs’ prospects.

This document is from a poster session and it illustrates and explains "the Hilltop Crossover Framework" in relation to the coordination of Medicare and Medicaid services to those who are dually eligible. This framework outlines how these services and costs are related.

The Congressional Budget Office examines the likely effects on federal spending of 115 health care reform options. Ch. 8 covers proposals on financing Medicaid and SCHIP and Ch. 10 covers long-term care options. HCBS-related options include: allowing all states to offer HCBS via Medicaid state plan amendments (#99); making HCBS a mandatory benefit (#100); and adjusting federal match rates to favor HCBS over nursing homes (#101). Also included is a presentation on the findings of the report.

<i>NOTE: The effective date for this rule has been postponed to April 3, 2009 and the comment period has been reopened, pending review by the Obama administration. See "Interim Rule" below.</i> CMS issued a Final Rule giving states the flexibility to define the scope of medical assistance covered by Medicaid by offering coverage of benchmark or benchmark-equivalent benefit packages to certain recipients. The file contains the official text of the rule as entered into the Federal Registry.