The Hilltop Institute

This presentation, delivered by Charles Milligan to the Medicaid and CHIP Payment and Access Commission (MACPAC) in Washington, D.C., addressed the issue of coordinating long-term care for persons eligible for both Medicare and Medicaid (dual eligibles). Milligan discussed Hilltop's research on Medicare/Medicaid cross-payer effects that found that Medicare and Medicaid financing do not align to promote home and community-based services.

With the growing role of home and community-based services in Medicaid long-term services & supports, an understanding of the different characteristics of the population transitioning from institutional care to HCBS, the trends occurring in LTSS & the effect of the different programs is needed. Hilltop developed a series of metrics to present to the Maryland Money Follows the Person Stakeholder Advisory Group now in the form of chart books. These metrics can be tailored for any state.

This report, which was presented at the Long-Term Care Interest Group Colloquium at the June 2011 AcademyHealth Annual Research Meeting in Seattle, Washington, discusses progress in rebalancing Medicaid long-term services and supports (LTSS) spending, how the Affordable Care Act can support states’ continued efforts to rebalance LTSS, and opportunities for future research to support continued system transformation.

The ACA creates a new framework to address community health needs as an integral component of the success of overall health reform. This symposium was designed to address current broad-based attempts to advance healthy communities and healthy living, which are less recognized contributions of the ACA than activities such as coverage expansion, health insurance regulation and reform, and changes in medical practice and payment. Learn more about the agenda and view the presentations.

Fourth and final in a series that explores the cross-payer effects of providing Medicaid long-term supports and services on Medicare acute care resource use, this 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.

Does providing Medicaid long-term supports and services influence dually eligible Medicaid recipients’ use of Medicare? Third in a series, this report is intended to provide background information on the interplay of Medicare and Medicaid resources using data from one state (Maryland) as an example for analysts who are examining similar issues at state and federal levels.

This series of chart books summarizes demographic, service utilization, and expenditure data for state fiscal years 2001 through 2008 on three Maryland Medicaid waiver programs — Older Adults, Living at Home, and Autism, and on nursing facility utilization among Maryland Medicaid recipients. These books are now available to the public online to monitor trends in these programs.

Studies show that 70% of the uninsured children in the United States, approximately 5 million children, are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) yet remain uninsured, despite varying State outreach efforts. Beginning in 2008, Maryland introduced Maryland Kids First Act, a new and innovative way to identify and enroll eligible children; through income tax filings. Preliminary efforts, results, and challenges are outlined here.

The second in a series, this report explores the cross-payer effects of providing Medicaid long-term supports and services on Medicare acute care resource use. Patterns of Medicaid eligibility, as well as resource use under both Medicare and Medicaid, are examined primarily within the context of service use-based groups that can be used to set rates for Medicaid capitation payments for managed long-term care.

More than 130 policymakers, health services researchers, practitioners, and policy experts discussed the measures and evidence to examine whether the expansion of home and community-based services has produced desired outcomes (quality, choice, cost, satisfaction and safety) in the long term for older adults and persons with disabilities. The day was divided into four sessions: (quality, consumer-direction, targeting candidates, determining cost-effectiveness). View the agenda and presentations.