The Medicaid Institute™ at United Hospital Fund

An initiative of United Hospital Fund

Improving Program Administration

The federal government has given states broad latitude to administer Medicaid, within federal guidelines, since the program's enactment under the 1965 amendments to the Social Security Act.  The administration of Medicaid in New York rests primarily with the State Department of Health, which serves as the State’s liaison to the federal government on Medicaid issues, works to ensure compliance with federal requirements, implements eligibility and benefits policies, oversees the Medicaid claims system, and establishes rates of payment for providers and health plans.  

More than a dozen state agencies play roles in administering Medicaid.  These include the Office of Mental Health, the Office of Mental Retardation and Developmental Disabilities, and the Office of Alcoholism and Substance Abuse—all of which administer programs funded primarily with Medicaid resources.  In addition, New York City and the 57 county governments across the state play significant roles in administering Medicaid’s application and eligibility determination process, as well as authorizations for receiving certain long-term care services.

Related Publications

Navigating the New York State Value-Based Payment Roadmap      

Published: 2015

A guide distilling and explaining the New York State Roadmap for Medicaid Payment Reform, which lays out New York’s ambitious goals of moving toward value-based payment from a fee-for-service model.

Redesigning Children’s Behavioral Health Services in New York’s Medicaid Program      

Published: 2015

This report gives an overview of the complex structure of New York Medicaid’s current services for children needing behavioral health services, reviews the State’s planned approach to reforming this system, and explores several important policy considerations for stakeholders as the reforms move forward.

Presentations from “Medicaid in New York: Transforming the Delivery System”      

Published: 2015

See presentations from the 2015 United Hospital Fund conference “Medicaid in New York: Transforming the Delivery System.”

    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.

    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.

    Mandatory Managed Long-Term Care in New York's Medicaid Program: Key Eligibility and Enrollment Issues      

    Published: 2014

    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.

    Home- and Community-Based Long-Term Care in New York's Medicaid Program: New Data on Service Use and Spending      

    Published: 2014

    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.

    Medicaid Managed Care for Children in Foster Care      

    Published: 2013

    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.

    Implementing Medicaid Health Homes in New York: Early Experience      

    Published: 2013

    This 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.

    Integrating and Improving Care for Dual Medicare-Medicaid Enrollees: New York’s Proposed Fully Integrated Duals Advantage (FIDA) Program      

    Published: 2012

    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.”

    Presentations from "Advancing Medicaid Reform"      

    Published: 2012

    These presentations were delivered at the conference "Advancing Medicaid Reform," held July 18, 2012.

    Implementing Long-Term Care Reform in New York's Medicaid Program      

    Published: 2012

    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.

    Implementing Behavioral Health Care Reform in New York's Medicaid Program      

    Published: 2012

    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.

    Measuring Quality for Complex Medicaid Beneficiaries in New York      

    Published: 2011

    This 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.

    Emergency Department Use in Brooklyn by Neighborhood      

    Published: 2011

    This United Hospital Fund presentation to members of New York State's Medicaid Redesign Team on September 21, 2011, examines emergency department use in 11 distinct Brooklyn communities.

    Medicaid Prescription Drugs: Purchasing and Management      

    Published: 2011

    This report explores the technical and policy decisions states can make when purchasing and managing prescription drugs in today’s Medicaid environment. It identifies best practices from around the nation and examines New York’s Medicaid prescription drug program in particular. The report also lays out how federal health reform affects the Medicaid drug benefit.

    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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