The Special Needs Plan (SNP) is a new type of Medicare Advantage plan created by the Medicare Modernization Act of 2003 (MMA). The plans target one of three special needs populations, including dual eligibles. This issue brief identifies the key issues that underlie one of the MMA’s central goals for dual-eligible SNPs—”the potential to offer the full array of Medicare and Medicaid benefits, and supplemental benefits, through a single plan”—and outlines their progress thus far. The brief observes that true coordination between SNPs and Medicaid programs, despite some state and federal initiatives, has largely failed to occur, and it discusses some of the reasons why. Consequently, the brief offers recommendations for improving dual-eligible SNPs’ prospects and extending their lives (legal authorization for SNPs is scheduled to expire at year-end 2008).
States that aim to develop Medicare Advantage Special Needs Plans for dual eligibles may choose from among three potential models discussed in this issue brief: 1) a Medicaid program in which the beneficiary voluntarily enrolls in a single managed care organization (MCO) that delivers both Medicaid and Medicare services; 2) a program in which the beneficiary is required to enroll in a Medicaid MCO but retains freedom of choice regarding whether to enroll in a capitated Medicare plan; and 3) an administrative services organization (ASO) approach, in which Medicaid retains a vendor to coordinate Medicaid services with the SNPs operating in the state. This issue brief also provides guidance on contractual issues important to state Medicaid agencies, and discusses environmental factors that influence the choice of models and the program’s prospects for success.
The Hilltop Institute (as the Center for Health Program Development and Management) prepared this report on behalf of the Maryland Health Care Commission and in collaboration with the Center for Social Science Research at George Mason University. Required by the Long-Term Care Planning Act of 2006 (House Bill 1342), the report examines the long-term care needs and costs for individuals aged 65 and older and persons with disabilities in 2010, 2020, and 2030. Total costs to the state for long-term supports and services are projected to increase more than threefold from 2005 to 2030 ($1.99 billion to $6.06 billion). The report concludes that planning must begin now or the state’s existing system for the provision of long-term supports and services is likely to be overwhelmed by the aging baby boomers and anticipated trends in the prevalence and intensity of disability.
On behalf of the Maryland Community Health Resources Commission, The Hilltop Institute (as the Center for Health Program Development and Management) conducted a study of funding and access issues that have an impact on the financial viability and continued growth of Maryland’s school-based health centers (SBHCs). The legislation establishing the Commission—the Community Health Care Access and Safety Net Act of 2005—required that the study be carried out. The study examined SBHC financing, assessed barriers to reimbursement, and recommended directions the Commission might pursue to expand access to SBHCs, promote increased reimbursement, and further develop the infrastructure and stabilize the financing of SBHCs.
This issue brief examines marketing and enrollment strategies in four states that have implemented coverage initiatives. It attempts to draw some conclusions on “best practices.” The Hilltop Institute (as the Center for Health Program Development and Management) conducted telephone interviews with state officials and health insurance agents and brokers from
Arizona, Montana, New Mexico, and Oklahoma to elicit information about the relative success of
various marketing strategies.
This report describes the services The Hilltop Institute (as the Center for Health Program Development and Management) provided to the Maryland Department of Health and Mental Hygiene (DHMH) under the Memorandum of Understanding between Hilltop and DHMH. In fiscal year 2007, Hilltop’s interdisciplinary staff provided a wide range of services, including: Medicaid program development and policy analysis; HealthChoice program support, evaluation, and monitoring; behavioral health and dental care analyses; research and analysis related to long-term supports and services; provider fee analyses; managed care payment development and financial monitoring; and data warehousing and website development.
This report, commissioned by the California HealthCare Foundation, surveyed six state/university health policy research partnerships to learn how they are organized and operate, how well they are working, what issues they have faced in developing and sustaining their collaborations, and how they have addressed those issues. One of the research partnerships studied is that which is maintained by the Maryland Department of Health and Mental Hygiene with The Hilltop Institute (as the Center for Health Program Development and Management) at UMBC, initiated in 1994.
This study, conducted for the Health Resources and Services Administration (HRSA), examines the practical experiences of a group of six states–Arizona, Michigan, New Mexico, New York, Oklahoma, and Utah–that have implemented affordable private and public coverage insurance products for workers with low income. The analysis documents the design elements that are important for establishing a workable program.
This policy brief, based on research conducted by Dr. Todd Eberly for his dissertation, examines whether a transition from fee-for-service to a managed care Medicaid program improved access to preventive well care services, and whether there were differential effects on service use for racial and ethnic minority youth.
The Hilltop Institute (as the Center for Health Program Development and Management) provided strategic and analytical support to the Federal Medicaid Commission during its deliberations in 2005-2006 and assisted with preparation of the Commission’s final report, released on December 29, 2006.