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; the state implemented a policy in 2006, for example, requiring certain disabled beneficiaries in New York City to join a managed care plan. 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 who typically remain in fee-for-service (as opposed to MMC) is also 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.