The Hilltop Institute

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 first in a series of reports, this study is a product of a larger effort by the state of Maryland and The Hilltop Institute to address questions related to the coordination of care for Medicaid recipients who are dually eligible for Medicare benefits. The report focuses on issues related to setting Medicaid payment rates. Although based on Maryland data alone, results from this study will be broadly relevant to other states as well.

This issue brief will present several approaches that attempt to tackle the underlying challenge of reducing nursing facility utilization and expenditures. These range from modifying the nursing facility reimbursement methodology; to converting nursing facilities to assisted living centers, paying nursing facilities to take beds off-line, and using capitated managed long-term care; to approaches with theoretical promise that have yet to be adopted in any state.