The Medicaid Institute™ at United Hospital Fund

An initiative of United Hospital Fund

Explaining Medicaid

Medicaid is a cornerstone of New York's health insurance system, providing coverage for more than five million of the state's residents, including more than three million in New York City. Accounting for about $49 billion in annual health care spending, Medicaid provides a broad range of health care services to diverse groups of New Yorkers. The program's responsibilities include four main roles:

  • Providing health insurance to low-income families;
  • Covering disabled individuals with no other access to services;
  • Supplementing Medicare for low-income elderly and disabled persons;
  • Providing subsidies directly to health care providers.

As of December 2013, about 5.2 million New Yorkers were enrolled in Medicaid, including:

  • 2.0 million children who are not disabled (not including 0.3 million enrolled in CHIP)
  • 1.9 million adults who are neither elderly nor disabled
  • 1.3 million individuals who are elderly, disabled, or both

Medicaid spending on health care services in New York totaled $49.1 billion in calendar year 2013; mainstream managed care and acute care services accounted for 54 percent of this spending, and long-term care and services for special populations accounted for 46 percent. Direct payments to Disproportionate Share Hospitals (DSH), those serving high concentrations of Medicaid patients and the uninsured, made up another $3 billion, and an additional $1.6 billion was spent on administrative costs.

Although elderly and disabled beneficiaries make up less than one-fourth of Medicaid enrollment, services provided to them account for about 62 percent of spending, most of which fills coverage gaps for beneficiaries also enrolled in Medicare. Children and adults who are neither elderly nor disabled make up more than three-quarters of enrollment, yet account for about 38 percent of Medicaid spending.

Related Publications

Performing Provider System Projects: Tackling the Health Needs of Communities      

Published: 2015

A snapshot of the projects selected by emerging Performing Provider Systems as part of their application for New York Medicaid’s Delivery System Reform Incentive Payment (DSRIP) program.

Medicaid Regional Data Compendium, 2014      

Published: 2014

This compendium gathers key data elements from various New York State Department of Health data releases and other related sources into short, easily digestible regional chartbooks providing a high-level overview of service utilization of New York’s Medicaid beneficiaries.

Presentations from "Medicaid: Collaborating on the Road to Reform"      

Published: 2014

These presentations and panels were the featured components of the conference "Medicaid: Collaborating on the Road to Reform," held July 15, 2014.

    New York’s Medicaid in Transition      

    Published: 2014

    This comprehensive overview of New York’s Medicaid program provides essential grounding in the dramatically changing program, focusing on the changes related to the federal Affordable Care Act and the State’s Medicaid Redesign Team; it also presents recent data on spending and enrollment and examines complex reforms underway or planned for the near future.

    New York's Medicaid Expansion of 2000-2010      

    Published: 2011

    This presentation by Michael Birnbaum was delivered at the Medicaid Congress in Washington, DC, on June 14, 2011.

    Medicaid in New York: The Road Ahead      

    Published: 2011

    This presentation by Michael Birnbaum discusses current enrollment and spending associated with New York's Medicaid program and lays out the challenges ahead.

    Medicaid in New York: Current Roles, Recent Experience, and Implications of Federal Reform      

    Published: 2010

    This Medicaid Institute publication lays out the challenges and opportunities facing New York’s Medicaid program, against a backdrop of a historic federal health care reform law and an unprecedented state budget deficit.


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