This study, which focuses on new Medicare-Medicaid enrollees in Maryland and the circumstances that shaped their initial eligibility for both programs, is an attempt to begin to address several of the gaps identified in a prior literature review. This report details the demographic and programmatic characteristics of new enrollees. Specifically, it serves as the vehicle for establishing an initial operational definition of new enrollees and developing the terminology needed to describe the circumstances surrounding initial Medicare-Medicaid eligibility.Also under Task 20 of CMS Contract HHSM-500-2005-00026I/Task Order HHSM-500-T0004, awarded by the Centers for Medicare & Medicaid Services to Thomson Reuters (Healthcare) Inc., Hilltop prepared Pathways to Medicare-Medicaid Eligibility: A Literature Review and New Medicare-Medicaid Enrollees in Maryland: Prior Medicare and Medicaid Resource Use.
This paper, prepared for the National Governors Association, discusses the progress states have made in moving away from institutional care for Long-Term Supports and Services and toward home and community-based programs. It analyzes the opportunities available through the Affordable Care Act and other programs whereby states can continue that progress even in a challenging budget environment.
The Affordable Care Act (ACA) requires states to either establish and operate a Health Insurance Exchange by 2014 or participate in the federal Exchange. On April 12, 2011, Governor O’Malley signed the Maryland Health Benefit Exchange Act of 2011, which established Maryland’s Exchange as an independent unit of the state government. The Act also established a Board of Trustees to oversee the Exchange. The Hilltop Institute was commissioned to develop a series of background papers in order to assist the Board in planning for the implementation of Maryland’s Exchange.This presentation, delivered by Senior Policy Analyst Martha Somerville, JD, MPH, discusses the background paper on health benefit plan contracting.
The Affordable Care Act (ACA) requires states to either establish and operate a Health Insurance Exchange by 2014 or participate in the federal Exchange. On April 12, 2011, Governor O’Malley signed the Maryland Health Benefit Exchange Act of 2011, which established Maryland’s Exchange as an independent unit of the state government. The Act also established a Board of Trustees to oversee the Exchange. The Hilltop Institute was commissioned to develop a series of background papers in order to assist the Board in planning for the implementation of Maryland’s Exchange.This presentation, delivered by Hilltop Director of Special Research and Development Anthony M. Tucker, PhD, discusses the background paper on market rules and adverse selection.
Senior Policy Analyst Ian Stockwell, MA, in conjunction with staff from the Maryland Department of Aging and the Maryland Department of Health and Mental Hygiene, presented at the 27th National Home and Community-Based Services (HCBS) Conference. This presentation discussed HCBS beginnings and momentum, including advocacy and costs, HCBS waivers, Aging and Disability Resource Centers (ADRCs), and Money Follows the Person (MFP); data and metrics to build community-based services; and using metrics to move forward. Stockwell focused on Hilltop’s research on utilization and expenditures of both institutional services and HCBS in Maryland, as well as on the Quality of Life Survey Hilltop conducted, to discuss how metrics were used and how they can be used going forward.
The Affordable Care Act (ACA) requires states to either establish and operate a Health Insurance Exchange by 2014 or participate in the federal Exchange. On April 12, 2011, Governor O’Malley signed the Maryland Health Benefit Exchange Act of 2011, which established Maryland’s Exchange as an independent unit of the state government. The Act also established a Board of Trustees to oversee the Exchange. The Hilltop Institute was commissioned to develop a series of background papers in order to assist the Board in planning for the implementation of Maryland’s Exchange.This presentation, delivered by Hilltop Hospital Community Benefit Program Director Donna Folkemer, MA, discusses the background paper on Navigator programs.
The Affordable Care Act (ACA) requires states to either establish and operate a Health Insurance Exchange by 2014 or participate in the federal Exchange. On April 12, 2011, Governor O’Malley signed the Maryland Health Benefit Exchange Act of 2011, which established Maryland’s Exchange as an independent unit of the state government. The Act also established a Board of Trustees to oversee the Exchange. The Hilltop Institute was commissioned to develop a series of background papers in order to assist the Board in planning for the implementation of Maryland’s Exchange.This paper provides background information on health plan contracting to the Maryland Exchange Board Advisory Committee and to provide foundational support for the analysis conducted by the vendor selected to perform the study. This report first provides an overview of health plan certification under the ACA and associated regulations recently proposed by the U.S. Department of Health and Human Services. It then describes Maryland’s individual and small group health insurance markets; the Maryland Insurance Administration’s premium rate review process; the non-selective form of contracting currently used by Maryland’s HealthChoice program; and the procurement process employed by the Maryland Department of Budget and Management to select health benefit plans offered to Maryland state employees, retirees, and their dependents.
The Affordable Care Act (ACA) requires states to either establish and operate a Health Insurance Exchange by 2014 or participate in the federal Exchange. On April 12, 2011, Governor O’Malley signed the Maryland Health Benefit Exchange Act of 2011, which established Maryland’s Exchange as an independent unit of the state government. The Act also established a Board of Trustees to oversee the Exchange. The Hilltop Institute was commissioned to develop a series of background papers in order to assist the Board in planning for the implementation of Maryland’s Exchange.This paper provides some basic background on how the health insurance market as a whole may respond to the collection of regulatory and structural changes that are envisioned under the ACA. It focuses first on the nature of and implications for adverse selection effects that may skew health plan enrollment, both inside and outside an Exchange. The paper includes a brief description of the insurance market in Maryland to establish a sense of the scale of participation inside and outside Maryland’s Exchange. This paper also introduces key components of ACA regulation that are intended to mitigate the financial risk for carriers operating within an Exchange in order to help provide a context for the collection of facets that Maryland will need to consider as its Exchange is established.
The Affordable Care Act (ACA) requires states to either establish and operate a Health Insurance Exchange by 2014 or participate in the federal Exchange. On April 12, 2011, Governor O’Malley signed the Maryland Health Benefit Exchange Act of 2011, which established Maryland’s Exchange as an independent unit of the state government. The Act also established a Board of Trustees to oversee the Exchange. The Hilltop Institute was commissioned to develop a series of background papers in order to assist the Board in planning for the implementation of Maryland’s Exchange.This background paper provides information on Navigator programs that, as defined by the ACA, provide public education and awareness about, distribute fair and impartial information about, and facilitate enrollment in qualified health plans. The background paper is also intended to provide foundational support for a formal study conducted on the design and operation of the Exchange’s Navigator Program and other appropriate consumer assistance mechanisms.
The Hilltop Institute conducted a literature review on pathways to Medicare-Medicaid eligibility at the request of the Medicare-Medicaid Coordination Office (MMCO) within the Centers for Medicare and Medicaid Services (CMS). This work was performed under Task Order RTOP CMS-10-022 awarded to Thomson Reuters (Healthcare), Inc., in 2010.Hilltop also prepared New Medicare-Medicaid Enrollees in Maryland: Demographic and Programmatic Characteristics and New Medicare-Medicaid Enrollees in Maryland: Prior Medicare and Medicaid Resource Use.