This Health Services Research article, published online in December 2010 and in print in January 2011, presents the findings of a Hilltop research project that identified factors associated with small group employer participation in New Mexico’s State Coverage Insurance (SCI) program. This article discusses administrative and cost issues that small employers considered when deciding whether to participate in the SCI program. It concludes that administrative and cost barriers to participation in SCI reported by employers suggest that the tax credit offered to small businesses under new federal provisions, which merely offsets the employer portion of premium, could be more effective if accompanied by additional supports to businesses. The study was partially funded by a grant to Hilltop and its partner, the New Mexico Human Services Department, from the Robert Wood Johnson Foundation State Health Access Reform Evaluation (SHARE).
Hilltop Director of Clinical and Quality Management Annette Snyder, PhD, delivered this presentation at the 138th American Public Health Association (APHA) Annual Meeting held November 6 through 10, 2010, in Denver, Colorado. The Impact of Selected Demographic, Mental Health, and Geographic Measures on Discharge from Nursing Homes among Working-Age Adults in Maryland discusses a study that examined factors associated with discharge to the community for working-age adults admitted to Maryland nursing homes over a five-year period. The study found that the strongest factors related to discharge to the community were an individual’s expressed preference for discharge and perceived support for community discharge.
With the growing role of home and community-based services (HCBS) in Medicaid long-term services and supports (LTSS), it is important to have a clear understanding of the different characteristics of the population transitioning from institutional care to HCBS, the trends occurring in LTSS over time, and the effect of the different programs. This resulted in Hilltop developing a series of metrics that were first presented to the Maryland Money Follows the Person (MFP) Stakeholder Advisory Group and are now available here in the form of chart books. These metrics can be tailored for any state to guide program development, explore other aspects of its LTSS system (such as opportunities for cost savings and program efficiency), and target populations for outreach efforts. This chart book discusses the second set of metrics, which focuses on the institutional characteristics of transitioned individuals.
Also in this series are: Institutional Utilization and Transitions,The Service Use and Cost of Transitioned Individuals, The Quality of Life Survey Responses, and a Summary.
In this issue brief released by the State Health Access Reform Evaluation (SHARE), researchers evaluate New Mexico’s State Coverage Insurance (SCI) program, a public/private partnership that provides access to subsidized health insurance for adults living below 200 percent of the federal poverty level. In particular, the program targets small business owners in New Mexico who may sponsor group enrollment in SCI for their employees.
The authors conducted a survey of SCI enrollees to ask about their employment, employer, prior health insurance coverage, SCI application process, SCI’s affordability, and more. They found that SCI is helping uninsured state residents with low incomes obtain health insurance, and that most of the employed SCI enrollees did not have health insurance in the year prior to enrolling.
With its premium subsidies and public/private collaboration, the authors concluded that SCI may serve as an example of what to expect under the Affordable Care Act (ACA), which aims to encourage small business to offer health insurance through tax cuts and exchange participation. Although they noted that additional variables will come into play once the ACA takes full effect, SCI is one of the few current examples of public/private initiatives to be examined in a post-reform environment. These findings highlight the importance of financial subsidies and size for small businesses and should be considered as ACA implementation moves forward.
Charles Milligan participated in a meeting for congressional and federal staff hosted by the National Health Policy Forum on October 29, 2010, in Washington, D.C. This meeting, the seventh of the Focus on Reform series providing an in-depth look at various components of the Affordable Care Act (ACA) and related implementation and operational issues, was entitled Medicaid Long-Term Services and Supports (LTSS) Provisions in PPACA. The session provided an overview of the Medicaid LTSS provisions enacted as part of the ACA, including the Community First Choice and Section 1915(i) state plan options; and the balancing incentive payments (BIP) and Money Follows the Person (MFP) programs, among others. Speakers described the provisions; strategies being employed by the Centers for Medicare & Medicaid Services (CMS) to assist states implement the various options, and opportunities and challenges facing states in implementation of the provisions. In his presentation, Milligan discussed the growth in Medicaid expenditures for LTSS; presented the results of a Hilltop study of Medicare/Medicaid cross-payer effects that found that Medicare and Medicaid financing do not align to promote home and community-based services (HCBS); described state and federal opportunities and barriers; and forecasted the take-up of LTSS options in the ACA.
Charles Milligan participated in a meeting for congressional and federal staff hosted by the National Health Policy Forum on October 29, 2010, in Washington, D.C. This meeting, the seventh of the Focus on Reform series providing an in-depth look at various components of the Affordable Care Act (ACA) and related implementation and operational issues, was entitled Medicaid Long-Term Services and Supports (LTSS) Provisions in PPACA. The session provided an overview of the Medicaid LTSS provisions enacted as part of the ACA, including the Community First Choice and Section 1915(i) state plan options; and the balancing incentive payments (BIP) and Money Follows the Person (MFP) programs, among others. Speakers described the provisions; strategies being employed by the Centers for Medicare & Medicaid Services (CMS) to assist states implement the various options, and opportunities and challenges facing states in implementation of the provisions.
In his presentation, Milligan discussed the growth in Medicaid expenditures for LTSS; presented the results of a Hilltop study of Medicare/Medicaid cross-payer effects that found that Medicare and Medicaid financing do not align to promote home and community-based services (HCBS); described state and federal opportunities and barriers; and forecasted the take-up of LTSS options in the ACA.
Charles Milligan was one of three experts who spoke at the UMBC Public Policy Forum entitled Health Care Reform: What Will It Mean to Maryland?, held October 22, 2010, in Baltimore, Maryland. In his presentation, entitled What Federal Health Care Reform Legislation Means to States, Milligan gave an overview of the new federal health reform legislation, the Affordable Care Act (ACA), and discussed its implications for states regarding Medicaid; exchanges; insurance-related issues; information technology; long-term services and supports; workforce issues; and preventive services and public health.
With the growing role of home and community-based services (HCBS) in Medicaid long-term services and supports (LTSS), it is important to have a clear understanding of the different characteristics of the population transitioning from institutional care to HCBS, the trends occurring in LTSS over time, and the effect of the different programs. This resulted in Hilltop developing a series of metrics that were first presented to the Maryland Money Follows the Person (MFP) Stakeholder Advisory Group and are now available here in the form of chart books. These metrics can be tailored for any state to guide program development, explore other aspects of its LTSS system (such as opportunities for cost savings and program efficiency), and target populations for outreach efforts. This chart book discusses the first set of metrics, which focuses on institutional utilization and transitions.
Also in this series are: The Institutional Characteristics of Transitioned Individuals, The Service Use and Cost of Transitioned Individuals, The Quality of Life Survey Responses, and a Summary.
Charles Milligan gave this presentation at the closing general session of the American Health Insurance Plans (AHIP) Medicaid Conference on September 16, 2010, in Washington, D.C. The session addressed issues surrounding coordination of coverage and seamless integration of benefits for dually eligible individuals. Milligan’s presentation painted a portrait of dual eligibles, using Maryland as an example; gave an overview of cross-payer effects for dual eligibles and of Hilltop’s research on cross-payer effects for dual eligibles in Maryland; and discussed the study’s findings and policy implications.
Charles Milligan participated in a roundtable at the 2010 AcademyHealth Research Meeting on June 28, 2010, in Boston, Massachusetts. His presentation 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.