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.
Hilltop has performed contractual services for the New Mexico Human Services Department (HSD) since 2004. Hilltop’s work with HSD is supported by a memorandum of understanding (MOU). This report presents Hilltop’s activities and accomplishments for fiscal year (FY) 2011 through this MOU.
This report, which was presented at the Long-Term Care Interest Group Colloquium at the June 2011 AcademyHealth Annual Research Meeting in Seattle, Washington, discusses progress in rebalancing Medicaid long-term services and supports (LTSS) spending, how the Affordable Care Act can support states’ continued efforts to rebalance LTSS, and opportunities for future research to support continued system transformation.To access the presentation on this topic, click here.
At the AcademyHealth Annual Research Meeting (ARM), Hilltop Director of Long-Term Services and Supports Cynthia H. Woodcock, MBA, and Maryland Department of Health and Mental Hygiene Deputy Secretary of Finance and former Hilltop Executive Director Charles J. Milligan, Jr., JD, MPH, presented this keynote address at the Long-Term Care Colloquium. Woodcock and Milligan presented highlights from their invited paper focusing on the success, to date, of rebalancing long-term care toward community settings and the implications of provisions in the Affordable Care Act for future rebalancing efforts.To access the invited paper, click here.
At the AcademyHealth Annual Research Meeting (ARM), Hilltop Director of Medicaid Policy Studies David Idala, MA, gave a presentation at a session on outreach and enrollment that examined how states could reach newly eligible populations under the Affordable Care Act (ACA). His presentation discussed the use of state income tax forms to identify children who are eligible for, but not enrolled in, Medicaid, and the lessons learned so far from the Maryland Kids First outreach initiative that could help states as they implement the ACA.
At the AcademyHealth Annual Research Meeting (ARM), Hilltop Policy Analyst Laura Spicer gave a presentation at a session on Addressing Cost and Affordability in Public Programs: Implications for the Affordable Care Act. Her presentation discussed findings from a Hilltop study funded by the Robert Wood Johnson Foundation’s State Health Access Reform Evaluation (SHARE) initiative. The study identified factors associated with small group employer participation in New Mexico’s State Coverage Insurance (SCI) program.
At the AcademyHealth Annual Research Meeting (ARM), Hilltop Senior Policy Analyst Karen E. Johnson, MS, gave this poster presentation, which was also authored by Hilltop Director of Special Research and Development Anthony M. Tucker, PhD, and UMBC Assistant Professor Yi Huang, PhD. The poster described the use of a propensity score matching methodology to identify comparison groups among Medicare-Medicaid beneficiaries who received Medicaid-paid long-term services and supports (LTSS) via home and community-based (HCBS) waivers versus those who did not receive LTSS. This matching technique was used to establish comparable treatment/control pairs for subsequent analysis of cross-payer effects of providing Medicaid-paid LTSS on Medicare acute care resource use, and could be used more generally to strengthen policy analyses that are based on observational and/or administrative data.