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The Hilltop Institute has released a new report entitled, Examining Rate Setting for Medicaid Managed Long-Term Care. The report, authored by Anthony M. Tucker, PhD, and Karen E. Johnson, MS, is the second in a series that explores the cross-payer effects of providing Medicaid long-term supports and services on Medicare acute care resource use. Patterns of Medicaid eligibility, as well as resource use under both Medicare and Medicaid, are examined primarily within the context of service use-based groups that can be used to set rates for Medicaid capitation payments for managed long-term care.

The first report, A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data, presented a basic analytical framework for analyzing Medicare and Medicaid data together. The Hilltop Crossover Framework was introduced in the guide as an orienting reference device for linked Medicare and Medicaid claims.

This second report examines overall patterns of resource use in further detail, including the presentation and simulation of a rate setting system to cover the Medicaid portion of costs associated with coordinated care in an integrated Medicaid and Medicare environment. The relationship between risk adjustment based on CMS Hierarchical Condition Categories that is used to establish payments to Medicare Advantage plans and Medicaid resource use is also explored.

The overarching study, Medicaid Long-Term Care Programs: Simulating Rate Setting and Cross-Payer Effects, which focuses primarily on issues related to setting Medicaid payment rates, is being conducted by Hilltop on behalf of the Maryland Department of Health and Mental Hygiene with funding support from the Robert Wood Johnson Foundation Changes in Health Care Financing and Organization (HCFO) initiative (Grant # 63756). Although based on Maryland data alone, the broader objective of the reports drawn from this study is to provide administrators and analysts across states and at the federal level with a framework and background to approach analyses that integrate Medicare and Medicaid resource use.

To learn more about the study, contact Anthony M. Tucker, PhD, project leader.