In response to the nation’s opioid epidemic, an increasing number of states are applying for and receiving Medicaid Section 1115 demonstration waivers for substance use disorders. The Centers for Medicare and Medicaid Services (CMS) created this opportunity under the authority of section 1115(a) of the Social Security Act for states to draw down federal Medicaid payments for facilities with greater than 16 beds that provide short-term residential treatment, which are otherwise prohibited through the Institution for Mental Disease (IMD) exclusion. Waiving the IMD exclusion allows states to offer short-term residential treatment, thereby offering the entire continuum of addiction treatment services to their Medicaid members based on widely accepted standards for evidence-based care.

This research was supported by the Robert Wood Johnson Foundation’s Research in Transforming Health and Health Care Systems program, which is administered by AcademyHealth. Hilltoppers Cynthia Woodcock, Alice Middleton, David Idala, and Matthew Clark co-authored this report, which describes the experiences of two early adopters of IMD waivers, Maryland and Virginia, in terms of their implementation and impact on the addiction treatment system for Medicaid members.

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This report describes the services The Hilltop Institute provided to the Maryland Department of Health (the Department) under the Master Agreement between Hilltop and the Department. The report covers fiscal year (FY) 2019 (July 1, 2018, through June 30, 2019). Hilltop’s interdisciplinary staff provided a wide range of services, including: Medicaid program development and policy analysis; HealthChoice program support, evaluation, and financial analysis; long-term services and supports program development, policy analysis, and financial analytics; and data management and web-accessible database development.

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Hilltop Senior Policy Analyst Charles Betley, MA, helped organize and participated on a panel titled Tobacco Costs: Present and Future Measurements and Effects at the 2019 Fall Research Conference of the Association for Public Policy Analysis and Management (APPAM) held in Denver, Colorado November 7-9, 2019. In his presentation, Betley talked about how policy studies are judged, based on both policymakers’ interests and researchers’ scientific directive. He then discussed the innovative methodology of the study: the use of state Medicaid claims data to estimate the costs of tobacco use to a state Medicaid program. Findings gleaned by this methodology are more timely and accurate than the use of national estimates alone.

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As states have embraced additional flexibility to change coverage of and payment for Medicaid services, they have also faced heightened expectations for delivering high-value care. Efforts to meet these new expectations have increased the need for rigorous, evidence-based policy, but states may face challenges finding the resources, capacity, and expertise to meet this need. By describing state-university partnerships in more than 20 states, this commentary describes innovative solutions for states that want to leverage their own data, build their analytic capacity, and create evidence-based policy. From an integrated web-based system to improve long-term care to evaluating the impact of permanent supportive housing placements on Medicaid utilization and spending, these state partnerships provide significant support to their state Medicaid programs. In 2017, these partnerships came together to create a distributed research network that supports multi-state analyses. The Medicaid Outcomes Distributed Research Network (MODRN) uses a common data model to examine Medicaid data across states, thereby increasing the analytic rigor of policy evaluations in Medicaid, and contributing to the development of a fully functioning Medicaid innovation laboratory. Hilltop Executive Director Cynthia Woodcock and Senior Policy Analyst Shamis Mohamoud contributed to this article published in eGEMs.

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Hilltop staff presented at the 2019 AcademyHealth Annual Research Meeting (ARM). Senior Policy Analyst Charles Betley, MA, presented this poster at both the State Health Policy Interest Group Meeting on June 1 and the ARM on June 3. This poster summarizes the work Betley led to analyze Mississippi Medicaid claims data and quantify the financial impact of tobacco use on Mississippi’s Medicaid program.

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This report describes the services The Hilltop Institute provided to the Maryland Department of Health (the Department) under the Master Agreement between Hilltop and the Department. The report covers fiscal year (FY) 2018 (July 1, 2017, through June 30, 2018). Hilltop’s interdisciplinary staff provided a wide range of services, including: Medicaid program development and policy analysis; HealthChoice program support, evaluation, and financial analysis; long-term services and supports program development, policy analysis, and financial analytics; and data management and web-accessible database development.

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This report presents to the Center for Mississippi Health Policy the results of a model for estimating tobacco-related costs for Mississippi Medicaid participants using administrative claims data for calendar years (CYs) 2016 and 2017. Tobacco-related costs were estimated to be $388 million in 2016 and $396 million in 2017. This report describes the various methods that were used to develop these cost estimates.

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Hilltop staff presented at the 2018 AcademyHealth Annual Research Meeting (ARM) in Seattle in June. Senior Policy Analyst Shamis Mohamoud, MA, gave this podium presentation, which provided an overview of Hilltop’s evaluation of the Maryland Health Home Program.

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The Heroin and Opioid Emergency Task Force, established by Maryland Governor Larry Hogan, recommends that the Maryland Department of Health review Maryland Medicaid rates for substance use disorder (SUD) services every three years. This chart book reviews SUD services provided by the Maryland Medicaid program from CY 2012 to CY 2016 and compares the rates with those of Delaware, Pennsylvania, Virginia, West Virginia, and Washington, DC.

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On March 29, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule on Medicaid and Children’s Health Insurance Programs; Mental Health Parity and Addiction Equity Act of 2008; the Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care Organizations (MCOs), the Children’s Health Insurance Program (CHIP), and Alternative Benefit Plans (ABPs) (https://www.gpo.gov/fdsys/pkg/FR-2016-03-30/pdf/2016-06876.pdf). This rule provides new requirements for Medicaid and CHIP compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equality Act of 2008 (MHPAEA) and the Affordable Care Act (ACA). Final MHPAEA regulations for group health insurance plans were issued in 2013. Much of this final rule extends the MHPAEA requirements for group health plans to Medicaid MCOs, CHIP, and ABPs, with exceptions and changes as applicable to address the unique aspects of state Medicaid mental health (MH) and substance use disorder (SUD) delivery systems. This document provides a high-level summary of the rule and highlights the changes to the proposed rule.

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Hilltop continues to work remotely, so please reach us by email. You can find our team members’ email addresses by going to their bios located on the Teams page of our website.