News & Bulletins Archive

Hilltop Executive Director Charles Milligan participated in a roundtable at the 2010 AcademyHealth Annual Research Meeting on June 28, 2010, in Boston, Massachusetts. The session, Balancing LTC: Can More Home and Community-Based Support Save Money While Improving Care?, explored the cost effectiveness of the most recent generation of home and community-based services (HCBS) programs and included the interaction between the Medicare and Medicaid programs, workforce concerns, and the need to better measure effectiveness. Milligan’s presentation, Dual Eligibles in Maryland, gave an overview of Hilltop’s research on cross-payer effects for dual eligibles in Maryland, provided the results of the study, and discussed some implications for policy. To view the presentation, click here. To access the full report, click here.

Hilltop Senior Research Analyst Harriet L. Komisar participated in a meeting for congressional and federal staff hosted by the National Health Policy Forum on June 18, 2010. This meeting, the third of the Focus on Reform series providing an in-depth look at various components of the Patient Protection and Affordable Care Act (PPACA) and related implementation and operational issues, was entitled Long-Term Services and Supports (LTSS) and the CLASS Act. Komisar’s presentation discussed financing sources for LTSS. To view the presentation, click here.

Hilltop Long-Term Supports and Services Director Cynthia H. Woodcock gave a presentation at the National Medicaid Congress pre-conference symposium entitled Managing Current and New Dual Eligibles on June 7, 2010. In the presentation, entitled Dual Eligibles in Nursing Facilities and Other Long-Term Care Settings, Woodcock discussed system coordination issues for dual eligibles in Maryland long-term care settings from a fiscal and service perspective and presented the opportunity for a coordinated care program; described New Mexico’s Coordination of Long-Term Services (CoLTS) program, which Hilltop helped New Mexico develop; and discussed whether coordinated long-term care was more efficient. To view the presentation, click here.

The Hilltop Institute has released a new report entitled, Cross-Payer Effects on Medicare Resource Use: Lessons for Medicaid Administrators. The report, authored by Anthony M. Tucker, PhD, and Karen E. Johnson, MS, is the fourth and final report in a series that explores the cross-payer effects of providing Medicaid long-term supports and services (LTSS) on Medicare acute care resource use. The 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 (or duals, for short). The view the report, click here. To view the bulletin, click here.

Hilltop Executive Director Charles Milligan participated in a meeting for congressional and federal staff hosted by the National Health Policy Forum on May 7, 2010. This meeting, the first in a new Focus on Reform series providing an in-depth look at various components of the Patient Protection and Affordable Care Act (P.L. 111-148) and related implementation and operational issues, was entitled Medicaid Coverage Expansions. Milligan’s presentation discussed state implementation requirements as well as the opportunities and challenges the coverage expansions present for states. To view the presentation, click here.

On March 24, 2010, Maryland Governor Martin O’Malley signed an Executive Order that created the Health Care Reform Coordinating Council (HCRCC) to make recommendations regarding Maryland’s implementation of the federal health reform legislation. The HCRCC, co-chaired by Lieutenant Governor Anthony Brown and Department of Health and Mental Hygiene Secretary John Colmers, has contracted with The Hilltop Institute to provide analysis and technical assistance throughout the HCRCC’s work, as well as to develop the two reports mandated by the Executive Order. To learn more about the HCRCC, click here.

Hilltop’s work for the Maryland Health Services Cost Review Commission (HSCRC) analyzing Maryland hospitals’ financial assistance and debt collection policies informed the modification of a law enacted in 2009 that requires acute care hospitals to establish state-approved debt collection policies and provide medically necessary care to patients with family incomes below 150% of the federal poverty level (FPL). The legislation, taking effect October 1, 2010, applies the debt collection requirements to chronic care hospitals and requires hospitals to provide reduced-cost care to patients with family incomes below 500% of the FPL if they face financial hardship—medical debt incurred over a 12-month period that exceeds 25% of their income. This legislation will decrease the payment burden for those patients who are struggling financially, thus increasing access to care. Hilltop provided in-depth analyses of these policies and practices, provided consultation to the HSCRC work group that developed the recommendations for the Maryland legislature, and testified before the legislature to discuss its findings. To see the HSCRC report that includes Hilltop’s findings, click here.

The Hilltop Institute carried out a resource mapping project for the state of Rhode Island as part of the state’s efforts to create a more accessible system of long-term services and supports under their federal Real Choice Systems Transformation grant. Hilltop interviewed state agency staff on their perceptions of service gaps and barriers to accessing the system of long-term services and supports; conducted a survey of providers of long-term services and supports in the state about current and future capacity to serve Rhode Islanders; and constructed a rebalancing model for projecting utilization and expenditures for Medicaid long-term services and supports through 2030.

Click here to view Hilltop’s final report. Click here to view Hilltop’s presentation on the final report. Click here to view Hilltop’s presentation on the rebalancing model.

Hilltop Executive Director Chuck Milligan presented his paper, entitled Reshaping Medicaid, at the National Governors Association (NGA) State Summit on Health Reform on March 15, 2010, in Washington, DC. This invitational summit brought together four key stakeholders from each state—the Governor’s health policy advisor, the state’s Medicaid Director, the state’s Insurance Superintendant, and another individual selected at the state’s discretion—to explore and discuss health reform from the state perspective. The session, entitled Modernizing and Expanding Medicaid, focused on emerging opportunities and challenges in Medicaid, related to and independent of federal health reform. Following presentation of his paper, Milligan moderated a panel discussion that included Cindy Mann, Director of the Center for Medicaid and State Operations, Centers for Medicare and Medicaid Services; Carol Steckel, Commissioner of the Alabama Medicaid Agency; and Jason Helgerson, Medicaid Director, Wisconsin Department of Health Services. To view the conference proceedings, click here.

Hilltop Executive Director Charles J. Milligan, Jr., participated on a panel at the 3rd Annual Medicaid Managed Care Summit in Washington, DC on February 25, 2010. The summit examined policy changes, Health Care Reform, and funding opportunities, as well as explored strategic answers to the core challenges in managed care. The panel, entitled Establishing Coordinated LTSS [long-term supports and services] Programs: Solutions for Medicaid, States, and Consumers that Promote Improved Quality and Flexibility, brought together Milligan and other experts in long-term care who presented challenges and solutions for the largely unmanaged portions of state Medicaid budgets dealing with long-term care services from a fiscal, medical, and operations perspective with an emphasis on the perspective of seniors and people with disabilities. The discussion included: identifying the personal care needs of seniors and people with disabilities; public policy considerations for personal care that preserve independence and freedom; examples of successful State LTSS programs, including the New Mexico Coordination of Long-Term Services (CoLTS) Program, which Hilltop helped develop; and demonstrating how managed care can transform to coordinated LTSS. To view the panel slides, click here 

Hilltop Medicaid Policy Studies Director David Idala, MA, discussed Maryland’s strategy for targeting public program enrollment efforts at a webinar hosted by the State Health Access Reform Evaluation (SHARE) on February 24, 2010, entitled Using Income Tax Information to Target Medicaid and CHIP Outreach. Idala’s presentation, entitled Maryland’s Kids First Act: Using Tax Forms to Identify Medicaid/CHIP-Eligible Children, discussed the findings of Hilltop’s evaluation and reviewed data collection, outreach strategies, impact on enrollment, and lessons learned. The evaluation was funded by SHARE, a national program of the Robert Wood Johnson Foundation®, with direction by the State Health Access Data Assistance Center at the University of Minnesota School of Public Health. To view the presentation, click here. To access the SHARE Issue Brief on the evaluation’s results, click here. To listen to the webinar, click here.

The Hilltop Institute has released a new report entitled, Examining the Medicare Resource Use of Dually Eligible Medicaid Recipients. The report, authored by Anthony M. Tucker, PhD, Karen E. Johnson, MS, Yi Huang, PhD, and Tonya Brewer, MPH, is the third in a series that explores the cross-payer effects of providing Medicaid long-term supports and services (LTSS) on Medicare acute care resource use. The report reflects an exploratory analysis of the relationships between Medicare and Medicaid resource use to address the question: Does providing Medicaid LTSS influence dually eligible Medicaid recipients’ use of Medicare resources and, if so, how and to what extent? Report results suggest two general aspects of these effects: (1) Medicaid LTSS provided in the community are associated with an increase in the number of Medicare services used with no, or limited, additional Medicare costs overall, and (2) Medicaid institutional supports offset Medicare resource use overall. The report also highlights analytic methods used, including propensity score matching techniques. The view the report, click here. To view the bulletin, click here.

Hilltop Executive Director Charles Milligan testified before the Maryland State Senate Finance Committee on February 2, 2010, regarding proposed legislation to require chronic care hospitals to develop a financial assistance policy for providing free and reduced–cost care, as well as to establish debt collection policies and procedures. This legislation was developed as a result of recommendations made by a work group convened by the Health Services Cost Review Commission (HSCRC) to review hospital financial assistance and debt collection policies and practices. Hilltop provided in-depth analyses of these policies and practices to inform the group’s work. Milligan testified on a panel with Robert Murray, executive director, and Steve Ports, principal deputy director, of HSCRC.

To disseminate the findings of the first formal evaluation of New Mexico’s State Coverage Insurance (SCI) program, The Hilltop Institute at UMBC has just released a new issue brief entitled Small Business Participation in the New Mexico State Coverage Insurance Program: Evaluation Results. The purpose of the study was to identify factors that have influenced employer participation in SCI. The evaluation was partially funded by the Robert Wood Johnson Foundation’s State Health Access Reform Evaluation (SHARE) program through a partnership between the New Mexico Human Services Department (HSD) and The Hilltop Institute. Hilltop Senior Research Analyst Anna S. Sommers, PhD, was principal investigator for the project. To view the issue brief, click here. To view the bulletin, click here.

The Hilltop Institute has just released a new series of chart books, entitled Medicaid Long-Term Supports and Services in Maryland, that summarizes demographic, service utilization, and expenditure data for state fiscal years 2001 through 2008 on three Maryland Medicaid waiver programs—the Older Adults Waiver, the Living at Home Waiver, and the Autism Waiver—and on nursing facility utilization among Maryland Medicaid recipients. These chart books, prepared for the Maryland Department of Health and Mental Hygiene and now made available to the public online, are intended to monitor trends in these programs. Hilltop plans to update the chart books annually. To view the bulletin, click here.