The Maryland Dual-Eligible Beneficiaries Chart Book provides an overview of Maryland dual-eligible beneficiaries with breakdowns by benefit category, age, race, gender, and county of residence; the cost to Medicare and Medicaid of providing care to this population; and the prevalence and costs of chronic health conditions. The chart book is the most recent edition in Hilltop’s chart book series, which includes publications on Medicaid long-term services and supports in Maryland and Medicaid services for individuals with traumatic brain injury and autism.
Related publications: Maryland Full-Benefit Dual-Eligible Beneficiaries’ Use of Medicare and Medicaid Services Preceding and Following a Medicare Inpatient Stay, An Analysis of Selected Mental Health Conditions among Maryland Full-Benefit Dual-Eligible Beneficiaries, and Characteristics of Maryland Full-Benefit Dual-Eligible Beneficiaries with Three or More Inpatient Stays.
Hilltop provided this report to the Maryland Dental Action Coalition (MDAC) to examine the cost and policy implications of expanding adult dental coverage under Maryland Medicaid. Currently, Maryland is among 15 states that only cover emergency dental benefits for adults, while 17 states provide limited but broader coverage, and 15 states provide extensive coverage, according to the Center for Health Care Strategies. The only exceptions to this coverage limitation in Maryland are dental services for pregnant women and individuals enrolled in the Rare and Expensive Case Management program.
On November 6, 2015, Hilltop Hospital Community Benefit Program Director Gayle D. Nelson, JD, MPH, gave this presentation and participated in a panel discussion at a session titled Health and Housing: Collaboration and Innovation at the 2015 National Housing Conference in New Orleans, LA. Nelson gave an overview of hospital community benefits; described how federal and state hospital community benefit laws and regulations can support communities addressing social determinates of health, including housing; and discussed how nonprofit tax-exempt hospitals and community development and affordable housing sectors might collaborate to develop healthy housing and communities.
This issue brief, the twelfth in a series, addresses Hilltop’s latest update of the Community Benefit State Law Profiles to reflect new community benefit legislation enacted between January 1, 2015, and October 31, 2015. Just two states—Connecticut and North Carolina—enacted new community benefit legislation during this time. This brief discusses these changes, as well as community benefit bills in twelve states that were introduced but not enacted in 2015 in order to better understand current trends in legislative action.
HealthChoice—Maryland’s statewide mandatory Medicaid managed care program—was implemented in 1997 under authority of Section 1115 of the Social Security Act. Since the inception of HealthChoice, the Maryland Department of Health has conducted five comprehensive evaluations of the program as part of the 1115 waiver renewals. Between waiver renewals, the Department completes an annual evaluation for HealthChoice stakeholders. This report is the 2013 annual evaluation of the HealthChoice program.
The Medicaid Long-Term Services and Supports in Maryland Chart Book, Volume 2, The Autism Waiver is the second chart book in a series of two that explores service utilization and expenditures for Medicaid-funded long-term services and supports in Maryland. Volume 1 in this series explores service utilization and expenditures for Maryland Medicaid’s Living at Home Waiver, Waiver for Adults, and Medical Day Care Waiver, as well as Maryland State Plan personal care services and Medicaid nursing facility utilization and expenditures.
Network adequacy refers to a health plan’s ability to provide reasonable access to sufficient in-network providers. Essential community providers (ECPs) serve low-income and medically underserved populations and include such providers as federally qualified health centers (FQHCs), Ryan White designated providers, family planning clinics, Indian health providers, and specified hospitals. Pursuant to federal regulations, the Maryland Health Benefit Exchange (MHBE) is interested in further developing policies for ECPs and provider network adequacy. To achieve this goal, the MHBE tasked its Standing Advisory Committee (SAC) to create a Network Adequacy and ECP Workgroup (Workgroup), charged with reviewing background materials and developing and assessing various policy options for provider network standards. The Workgroup included 16 members, representing carriers, providers, and consumer advocacy organizations.
This report summarizes the background materials Hilltop developed for the Workgroup and the Workgroup’s discussions of policy options. The purpose of this report is to provide input to the MHBE Board of Trustees for the 2017 benefit year.
This chart book summarizes demographic and Medicaid service and expenditure data for Marylanders using LTSS in state fiscal years (FYs) 2010 through 2013. Medicaid programs and services addressed in this chart book include the Living at Home (LAH) Waiver, the Medical Day Care Services (MDC) Waiver, the Waiver for Older Adults (WOA), Medical Assistance Personal Care (MAPC) Program, Medicaid Nursing Facility Services, and Money Follows the Person.
With the establishment of the Exchange in Maryland law in 2012, the memorandum of understanding (MOU) that supported Hilltop’s work on health care reform between the Maryland Department of Health and Mental Hygiene (DHMH) and Hilltop transitioned to one between the Maryland Health Benefit Exchange (MHBE) and Hilltop.
This report presents the activities and accomplishments of that MOU, covering April 1, 2014, through April 30, 2015.
Hilltop Hospital Community Benefit Program Director Gayle D. Nelson, JD, gave this presentation at a Payers and Providers webinar titled The New Era: Hospital Community Benefits & Patient Financial Assistance on June 26, 2015. The webinar was attended by a national audience of state policymakers, community benefit directors of hospitals and health plans, financial officers, and providers. In her presentation, Nelson gave an overview of Affordable Care Act (ACA) §9007, “Additional Requirements for Charitable Hospitals,” which added I.R.C. §501(r) when it was enacted in 2010; gave a regulatory history from 2010 to the present; and discussed the Final Rules and their stipulations that were promulgated on December 31, 2014