Publications

Evaluation of the Maryland Medicaid HealthChoice Program: CY 2019 to CY 2023

In 1997, Maryland implemented HealthChoice—a statewide mandatory Medicaid and Children’s Health Insurance Program (CHIP) managed care program—under authority of a waiver through §1115 of the Social Security Act. The provisions of the Affordable Care Act (ACA) that went into effect in 2014 marked another milestone by extending quality coverage to many more Marylanders with low income. Over 25 years after its launch, HealthChoice covers close to 90% of the state’s Medicaid and Maryland Children’s Health Program (MCHP) populations. Since the inception of HealthChoice, the Maryland Department of Health (the Department) has requested and received seven §1115 waiver renewals.

The Hilltop Institute, on behalf of the Department, evaluates the program annually; this evaluation covers the period of calendar year (CY) 2019 through CY 2023.

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Medicaid Long-Term Services and Supports in Maryland: FY 2019 to FY 2023, Nursing Facility Services. A Chart Book

This chart book explores utilization and expenditures for Medicaid-funded LTSS in Maryland for state fiscal year (FY) 2019 through FY 2023. The focus of this chart book is on Medicaid nursing facility services, with one chapter that illustrates Maryland’s efforts at providing home and community-based services (HCBS) to an increasing number of Medicaid recipients who may otherwise be served in nursing facilities.

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What’s the Impact of Phasing Provider Taxes Down to 3.5% for Medicaid Expansion States?

The Hilltop Institute has released updated analysis of the Medicaid provider tax provisions of the Senate budget reconciliation bill. The estimates, which model the version of the bill released from the Senate Finance committee on June 16, 2025, update Hilltop’s earlier analysis of provider taxes. Authored by Hilltop Director of Analytics & Research Dr. Morgan Henderson, Senior Data Scientist Dr. Leigh Goetschius, and Executive Director Alice Middleton, this analysis uses hospital provider tax rates and net patient revenue data to calculate the estimated state-level impacts of the proposed Senate legislation. The authors find that, once the provider tax reductions are fully implemented as of 2031, this legislation would reduce federal funding to 18 Medicaid expansion states by over $11.9 billion annually. Moreover, the impact will not be uniform: the impact will be largest in states with high hospital provider tax rates. Specifically, the authors find that Arizona, New Hampshire, Nevada, Iowa, Vermont, and Michigan would each at lose least 7.5% of their federal Medicaid funding as a result of this bill.

While the proposed legislation proposes a suite of Medicaid policy changes that would interact in various ways, this analysis only considers the hospital provider tax change in isolation. This is the latest in a series of Hilltop analyses focused on modeling state-level impacts of potential federal Medicaid policy changes.

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