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NYS Comptroller

THOMAS P. DiNAPOLI

2016 FINANCIAL CONDITION REPORT

Public Health


Medicaid Eligilbes in New York Medicaid Costs and Eligible Recipients Medicaid Costs

Medicaid Enrollment Increases

  • Average monthly enrollment in the State’s Medicaid program exceeded 6.2 million in State Fiscal Year (SFY) 2015-16, an increase of 322,237 or 5.4 percent over last year. The increase occurred despite a significant decrease in Medicaid enrollment starting in January 2016, when the State began transitioning legally residing immigrants enrolled in Medicaid to the Essential Plan (see below).
  • Compared to last year, average monthly enrollment for:
    • adults increased by 183,395 (7.4 percent) to 2.6 million, accounting for the largest increase in enrollment;
    • children with Medicaid coverage increased by 73,780 (3.5 percent) to 2.2 million;
    • elderly recipients increased by 31,446 (6.5 percent) to 518,021;
    • blind or disabled recipients decreased by 22,689 (2.9 percent) to 750,545; and
    • “other” eligible recipients, largely legal immigrants, increased by 56,305 (75.7 percent) to 130,682.
  • Medicaid recipients in managed care plans increased by 285,526 (6.4 percent) to nearly 4.8 million, or 76.0 percent of all recipients. This increase reflects the enrollment of most new recipients into managed care plans and the continued transition of most populations from fee-for-service to Medicaid managed care.

Medicaid Spending Increases, Largely Due to Additional Federal Payments From the Federal Affordable Care Act (ACA)

  • Compared to last year, combined local, State and federal spending on Medicaid claims increased by $3.1 billion (5.7 percent) to nearly $57.7 billion. This increase largely reflects additional federal Medicaid payments, most of which are associated with the ACA.
  • Children and adults represented over three-quarters of all average monthly enrollees, but only 41.8 percent of the overall costs of Medicaid claims for the State. Elderly, blind and disabled enrollees made up less than a quarter of eligible recipients, but accounted for 54.2 percent of Medicaid claims costs.

The State Establishes the Essential Plan

  • In 2015, New York State joined Minnesota to become the only states in the nation to establish a Basic Health Program, a new low-cost health insurance option authorized by the ACA and largely funded by the federal government. In New York State, the Basic Health Program is known as the Essential Plan.
  • The Essential Plan is available to individuals who are under 65, not eligible for Medicaid or the Child Health Insurance Program, without access to affordable coverage and with incomes at or below 200 percent of poverty.
  • While the Essential Plan is not a Medicaid program, the State saved New York Medicaid costs of approximately $1 billion in SFY 2015-16 by transitioning approximately 260,000 legally residing immigrants enrolled in Medicaid but not eligible for federal Medicaid reimbursement to Essential Plan coverage.
  • In SFY 2015-16, federal funds covered 92 percent of Essential Plan costs, with State funds covering the remaining 8 percent. Individuals with incomes greater than 150 percent but at or below 200 percent of poverty pay $20 monthly premiums to private health plans participating in the program. Individuals with incomes at or below 150 percent of poverty have no monthly premium.
  • All participating health plans cover inpatient and outpatient care, physician services, diagnostic services and prescription drugs with low out-of-pocket costs and no annual deductible. Enrollees have no out-of-pocket costs for preventive care, including routine office visits and recommended screenings.

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