About the Annual Managed Care Enrollment Report

About the Report

The Managed Care Plan Enrollment Report is the New York State Department of Health's (NYSDOH) annual publication of enrollment by county for managed care plans licensed to operate in New York State. The enrollment reflected in this report involves membership for organizations under their managed care license only (Article 44 licenses). While the organizations may have additional membership through products under other health insurance licenses, those members are not included in this report.

There are two types of managed care plans in New York State included in this report: Health Maintenance Organizations (HMOs), and Prepaid Health Service Plans which primarily enroll Medicaid and Child Health Plus beneficiaries. Partial capitation managed care plans, managed long term care plans, and HIV Special Needs Plans, are not included in this report.

About the Data

The information included in this report is collected annually as of December 31st of each year. The county-specific data is self-reported by the managed care plans based on the addresses of their enrollees.

Two sources of data are used for this report. Membership for Commercial HMO and point of service (POS), self pay, Healthy New York and Medicare for Article 44 organizations are obtained from the Annual Data Requirements for Health Maintenance Organizations, submitted to the State Insurance Department. The NYSDOH Medicaid Encounter Data System (MEDS) serves as the source for the Medicaid, and Family Health Plus enrollment data. Child Health Plus enrollment figures are from the Department's Office of Health Insurance Programs, Division of Coverage and Enrollment.

About the Sections

This report contains two sections using the same enrollment data. The first section is sorted by county and the second section is sorted by plan. For purposes of this report, the "Unclassified NYC" section (pg. 25) includes Medicaid enrollees for whom New York City is the county of fiscal responsibility, but who have zip codes that are invalid or cannot be allocated to any borough. The penetration rate for each of the counties is calculated using managed care plan enrollment divided by population estimates from the 2000 Census provided by the NYS Department of Economic Development. (Total NYS population estimate as of July 1, 2008 is: 19,490,297.)

If you would like additional information regarding this report, please contact:

  • Division of Quality and Evaluation
    Office of Health Insurance Programs
    NYS Department of Health
    Empire State Plaza
    Corning Tower, Room 1938
    Albany, NY 12237
    (518) 486 - 9012

Additional Information