About the Medicaid Managed Care Enrollment Reports
The Medicaid Managed Care Enrollment Report shows the number of Medicaid recipients currently enrolled and the number of Medicaid recipients eligible to enroll in New York State's Medicaid managed care program. The data is presented for each Managed Care Organization by county and Medicaid Aid Category.
Please note that the Medicaid AID Categories reflect terminology changes resulting from welfare reform. The Aid to Dependent Children (ADC) category is now called Temporary Assistance to Needy Families (TANF) while the Home Relief (HR) category is called Safety Net Assistance (SNA). The Medicaid-Only beneficiaries are included with each of the respective ADC, HR, or SSI cash assistance aid categories.
Note: As of January 2013, these columns have been removed from the report.
The managed care eligible counts reflect total Medicaid eligibles less recipients that can be identified as excluded from managed care enrollment (for example, dually eligibles or those in nursing homes). Eligible counts include recipients who are not mandated to enroll (exempt population) but may voluntarily do so. Eligible counts are updated periodically as more recent data becomes available. Please note that the month on which the current eligible count is based is posted in Note 1 on each Enrollment Report.
Effective with the July 2003 report, the data source for determining the number of Medicaid recipients enrolled in the New York State Medicaid Managed Care Program has been changed.
Previously, total enrolled counts were based on information from the Medicaid Encounter Data System (MEDS). The MEDS reflects the number of individuals enrolled as of the end of the month, which results in a delayed posting of the enrollment report until at least 15 or more days following the end of the enrollment month. To post the Enrollment report in a more timely manner, we have changed the source of our enrollment counts to the primary and secondary roster reports. These reports provide enrollment counts as of the 1st of the month thereby allowing the report to be posted the same month of enrollment. Because of the timing difference, the enrollment based on rosters will vary from the enrollment based on MEDS.
Expected Penetration Rate Columns
Note: As of July 2008, these columns have been removed from the report.
The expected target column in the enrollment report reflects the expected ADC/HR proportion of county eligibles that would ultimately be enrolled in managed care. The "Expected Target" takes into account two factors that impact a county's ability to enroll 100% of its Medicaid managed care eligibles:
- A number of Medicaid recipients are not able to enroll for a particular month due to their Medicaid eligibility not being determined until after the month in question; and
- A portion of the exempt* population will choose not to enroll with a managed care plan.
% of Target
The second column, "% of Target", shows actual enrollment as a percentage of the "Expected Target".
It is anticipated that the penetration rate target will be adjusted periodically as more current information about the number of exempt eligibles who voluntarily enroll becomes available.
Family Health Plus Enrollment/Managed Long Term Care Enrollment/Medicaid Advantage Enrollment/Medicaid Advantage Plus Enrollment
A monthly enrollment report for the Medicaid Managed Long Term Care Program (MLTCP) was added to the Monthly Medicaid Managed Care enrollment report beginning September 2002. This report is presented by plan and county. In August 2008 the report was revised to include the plan's status as a PACE or Partial Capitation plan. The source of the enrollment counts is also the monthly roster.
A monthly enrollment report for the Family Health Plus Program (FHP) has been added to the Monthly Medicaid Managed Care enrollment report beginning March 2005. This report is presented by County, Plan and Adults with Children and Adults without Children. The source of the enrollment counts is also the monthly roster.
In March 2006, a monthly enrollment report for the Medicaid Advantage Program (MA) was added to the Monthly Medicaid Managed Care enrollment report. Later in August 2008 a monthly Medicaid Advantage Plus enrollment report was also included (MAP). The reports present Medicaid Advantage and Medicaid Advantage Plus enrollment by county and plan. As with the other reports the source of both enrollment counts is the monthly roster.
The FHP, MLTCP, MA, and MAP reports can be accessed in an EXCEL spreadsheet by clicking on the separate spreadsheet indicated by the tabs Family Health Plus, Long Term Care, Medicaid Advantage and Medicaid Advantage Plus respectively. The FHP PDF report follows the Medicaid Managed Care enrollment report and the MLTCP PDF report follows the FHP PDF report and finally the MA and MAP PDF reports are added.
Posting of the Report
Posting of the monthly Medicaid Managed Care Enrollment Report will generally occur during the third week of the enrollment month.
*Exempt recipients are not mandated to enroll in Medicaid managed care, but are eligible to enroll voluntarily. This would include Medicaid recipients with AIDS, HIV or a serious and persistent mental illness. Excluded recipients, such as residents in a long-term care facility, are precluded from enrolling in managed care.