The majority of New York's beneficiaries are now enrolled in Medicaid managed care (MMC), and policymakers are extending MMC's reach to include more disabled and elderly enrollees. While MMC holds promise for improving services, New York's experience to date indicates that meeting that promise will require changes in the ways providers and patients, respectively, deliver and access health care services.
Rethinking service delivery for "high-cost" Medicaid beneficiaries, whether in MMC or another form form of care management, is a priority because this small share of enrollees represents some of the program's most complex patients and accounts for a large share of Medicaid spending. Through the establishment of the Medicaid High-Cost Care Initiative, the Fund, collaborating with researchers and clinicians, explored opportunities to improve Medicaid service delivery for these patients.
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.
This issue brief provides an overview of New York State’s mandatory Medicaid managed long-term care enrollment policy, which the State began implementing in 2012. It examines the growth in enrollment from 2010 to 2013, as well as growth by region and product line; and discusses key operational issues related to the major changes in eligibility and enrollment processes triggered by shifting high-need Medicaid beneficiaries from fee-for-service into managed care.
This data brief documents the shift of Medicaid home- and community-based services from fee-for service into managed care between 2010 and 2013. It presents regional differences in services and spending, and evaluates the growth in Medicaid managed long-term care and the corresponding decline in fee-for-service home- and community-based services, particularly in personal care use, reflecting an explicit policy goal of New York.
This Medicaid Institute reports examines the different models through which New York State could implement care management for a group of high-need Medicaid beneficiaries: children in foster care.
Published: 2013This Medicaid Institute report describes the initial stages of implementing New York State’s health home initiative, a care management and coordination vehicle for Medicaid enrollees with chronic conditions.
This report from the Medicaid Institute at United Hospital Fund focuses on a proposed New York State program to better manage care of beneficiaries who are enrolled in both Medicare and Medicaid, commonly referred to as “duals.”
One of two jointly released Medicaid Institute reports examining implementation of Medicaid policy changes in New York, this report explains and considers potential strategies and options for improving the management of long-term care services for elderly and disabled Medicaid beneficiaries, and addresses the issues of balancing residential and community-based long-term care, refining reimbursement for long-term care services, and providing effective care management.
One of two jointly released Medicaid Institute reports examining implementation of Medicaid policy changes in New York, this report explains the roles and responsibilities of newly authorized regional behavioral health organizations; discusses the long-term challenges of integrating behavioral and physical health care delivery; and considers how the State might measure effectiveness of care.
Published: 2011This Medicaid Institute report points to the importance of quality measurement for Medicaid beneficiaries with complex needs — specifically those with multiple chronic conditions, behavioral health conditions, and long-term care needs — as a means of improving care but also as a tool to advance the state’s strategies of reimbursement reform and service delivery redesign for vulnerable and high-cost populations.
This report paints a detailed picture of New York's Medicaid beneficiaries receiving care for mental health and substance abuse conditions—who they are, what kind of services they regularly seek, and how they differ from or resemble other Medicaid beneficiaries not receiving the same kinds of care.
This report examines policy considerations faced by New York on how to care for Medicaid beneficiaries with mental health and substance abuse conditions.
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.
This paper, written by staff from the Lewin Group for the Fund's Medicaid Institute, describes New York's program for providing transportation services to Medicaid beneficiaries, considers the strengths and weaknesses of the state's program, and assesses alternative approaches to improve the program and reduce costs.
A report from the United Hospital Fund's Medicaid Institute™ concludes that, for Medicaid beneficiaries with chronic physical health conditions and serious and persistent mental illness, the more integration of physical and behavioral health care services the better.
This report lays out the formidable challenges to improving care for certain high-cost Medicaid beneficiaries, focusing on those with multiple and substantial needs who rely disproportionately on costly hospital inpatient services.
This publication is the most comprehensive independent report produced in recent years examining the status of managed care for Medicaid beneficiaries in New York.