Browsing by Author "Milligan, Charles J., Jr."
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Item Coordinating Care for Dual Eligibles: Options for Linking State Medicaid Programs with Medicare Advantage Special Needs Plans(The Commonwealth Fund, 2008-02) Milligan, Charles J., Jr.; Woodcock, Cynthia H.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.Item Impact of the Medicare Prescription Drug Benefit on Home- and Community-Based Services Waiver Programs(The Hilltop Institute, 2005-04) Milligan, Charles J., Jr.Home- and community-based services waiver programs enable many individuals who are dually eligible for Medicare and Medicaid to avoid nursing homes. However, there was concern at the time that access to prescription drugs may be impeded with the transfer of drug coverage from Medicaid to Medicare in January 2006, threatening the ability of dual eligibles to remain in the community. This issue brief examines the likely impact of the new Medicare drug benefit in Maryland and recommended federal policy remedies.Item Medicare Advantage Special Needs Plans for Dual Eligibles: A Primer(The Commonwealth Fund, 2008-02) Milligan, Charles J., Jr.; Woodcock, Cynthia H.The Special Needs Plan (SNP), a new type of Medicare Advantage plan created by the Medicare Modernization Act of 2003 (MMA), targets one of three special-needs populations—including beneficiaries who qualify both for Medicare and Medicaid benefits (“dual eligibles”), the focus of this issue brief. It identifies the key issues that underlie one of the MMA’s central goals for dualeligible SNPs—“the potential to offer the full array of Medicare and Medicaid benefits, and supplemental benefits, through a single plan”—and it 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).Item Money Follows the Person: Reducing Nursing Home Facility Utilization and Expenditures to Expand Home- and Community-Based Services(Rugers Center for State Health Policy, 2005-01) Milligan, Charles J., Jr.A major challenge to expanding home- and community-based services (HCBS) alternatives to institutional long-term care is finding funding sources to pay for HCBS. Unless states can develop policy interventions that actually reduce expenditures in institutional settings, any expansion in HCBS requires new state funds. This issue brief presents several approaches states can use to reduce nursing facility utilization and expenditures in order to make funds available to expand HCBS.Item Nursing Facility Payment Policy: Comparing Maryland to Other States(The Hilltop Institute, 2009-09-02) Milligan, Charles J., Jr.This presentation, delivered by Charles Milligan to the Maryland Department of Health and Mental Hygiene (DHMH) Long-Term Care Payment Advisory Committee (LTC PAC), describes findings from a Hilltop study that examined the Medicaid nursing facility (NF) payment systems of all 50 states and the District of Columbia. It also compares Maryland’s payment system to that in other states.Item Nursing Facility Payment Policy: Comparing Maryland to Other States(The Hilltop Institute, 2009-09-02) Milligan, Charles J., Jr.Charles J. Milligan, Jr., JD, Hilltop’s executive director, gave a presentation entitled, Nursing Facility Payment Policy: Comparing Maryland to Other States, in which he described findings from a Hilltop study that examined the Medicaid nursing facility (NF) payment systems of all 50 states and the District of Columbia, and then compared Maryland’s payment system to that in other statesItem Participation in the New Mexico State Coverage Insurance (SCI) Program: Lessons from Enrollees(The Hilltop Institute, 2010-11) Spicer, Laura; Sommers, Anna S.; Boddie-Willis, Cynthia; Mikow, Asher; Abraham, Jean; Milligan, Charles J., Jr.; Spaulding-Bynon, MariIn 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.Item Small Business Participation in the New Mexico State Coverage Insurance Program: Evaluation Results(The Hilltop Institute, 2010-01) Sommers, Anna S.; Spicer, Laura; Mikow, Asher; Abraham, Jean; Milligan, Charles J., Jr.This Hilltop Issue Brief disseminates the findings of the first formal evaluation of the New Mexico State Coverage Insurance (SCI) program. The study objective was to identify factors that have influenced employer participation in SCI. The study findings highlighted in the brief draw from two employer surveys fielded in 2008 and site visits to interview program stakeholders conducted in July 2008 and May 2009. The evaluation was partially funded by the Robert Wood Johnson Foundation’s State Health Access Reform Evaluation (SHARE) program through a partnership between the New Mexico Human Services Department (HSD) and The Hilltop Institute.