Tag Archives: NY
Market Overview PDF
Download NowNew-York_090924.pdf
NY Medicaid Global Spending Cap Reports, 2019-23
NY Medicaid Global Spending Cap Reports, 2019-23
NY Medicaid External Quality Review, Utilization Review, Quality Improvement and AIDS Intervention Management System Activities Solicitation of Interest, 2019-22
1. NY Medicaid External Quality Review, Utilization Review, Quality Improvement and AIDS Intervention Management System Activities Solicitation of Interest, Issued August 21, 2019
2. Solicitation of Interest Checklist
3. Contract Extension Request
NY Releases Regulations Implementing Changes to Personal Care and Consumer Directed Services
The New York State Department of Health (DOH) released on July 1, 2020, amended regulations to implement changes advanced by the Medicaid Redesign Team II and adopted in the 2020-21 Enacted Budget impacting Personal Care Services and the Consumer Directed Personal Assistance Program (CDPAP). These amendments, which will appear in the New York State Register on July 15, are being promulgated to implement long term care reform proposals, including instituting new eligibility requirements, establishing an independent assessor, reducing the frequency of assessment from semi-annual to annual, requiring independent physician orders, and establishing a clinical review for high need cases.
The MRT II was reconstituted to identify a number of proposals to contain spending growth in the State’s Medicaid program, including significant growth in Long Term Care spending, many of which were advanced and codified in the State’s enacted budget to achieve $2.5 billion in State Medicaid savings.
New York Medicare Market Overview
Download NowNew-York_Medicare_031021.pdf
PA-based Highmark to Acquire HealthNow BCBS License in Western NY
Modern Healthcare reported on June 16, 2020, that Pennsylvania-based Highmark Health has agreed to acquire the Blue Cross Blue Shield license of New York-based HealthNow in an affiliation agreement that also includes HealthNow’s administrative services only business. Under the terms of the deal, Highmark would become the primary Blue Cross Blue Shield licensee for HealthNow’s eight-county service in western New York. Read More
NY Safety-Net Hospitals Face Financial Uncertainty
The Wall Street Journal reported on June 11, 2020, that New York safety-net hospitals are struggling with the financial impact of COVID-19 and uncertainty regarding federal relief funds. New York has 27 hospitals with at least 50 percent of Medicaid or self-pay patient discharges. Read More
NY Medicaid Enrollment Could Grow by Up to 1.2 Million, Study Says
Modern Healthcare reported on June 10, 2020, that Medicaid enrollment in New York could increase by 1.2 million if unemployment reaches 25 percent, according to the Urban Institute. Enrollment would increase by 641,000 people if unemployment reaches 15 percent. New York Governor Andrew Cuomo said that the state might need to cut spending by an additional 20 percent without additional federal support. Read More
NY SNP Membership at 369,815, Mar-20 Data
New York had 369,815 Special Needs Plan members as of March 2020.
MLRs at 10 NY Medicaid MCOs Average 91.1%, 2019 Data
Average medical loss ratio among 10 New York Medicaid plans averaged 91.1% in 2019. Average per member per month premiums among these 10 plans were $914 in 2019. Note: New York’s three among the largest Medicaid plans – Fidelis Care/Centene, HealthFirst and MetroPlus – aren’t required to file financials with NAIC. These three plans combined account for about half of Medicaid managed care membership in the state. Thus, the financials presented here only provide a limited view of the New York Medicaid market.
