State Health Commissioner Shah Announces Medicaid Redesign is Working

Better Quality, Better Patient Outcomes, Lower Costs – even as Medicaid Enrollment Increases

ALBANY, N.Y. (May 08, 2013) - New York State Department of Health Commissioner Nirav R. Shah, M.D., M.P.H., today highlighted data that shows New York's efforts to reform and restructure Medicaid are working: Medicaid costs are decreasing as enrollment is increasing, and the quality of the program is also receiving high marks.

Initiatives developed by Governor Andrew Cuomo's Medicaid Redesign Team (MRT) continue to "bend the cost curve" on services provided to Medicaid beneficiaries, especially in New York City. This improvement is primarily reflected in long term care services, which were the primary cost driver in spending growth before the Governor created the MRT in January 2011.

"New York's Medicaid program has undergone historic change under Governor Cuomo's leadership, and all New Yorkers are benefiting from these reforms," Commissioner Shah said. "Medicaid Redesign initiatives are successfully improving the quality of care and individual health outcomes for Medicaid members, while reducing costs for New York taxpayers. New York has proven that health reform can produce positive results, and we continue to explore ways to further improve Medicaid in New York State."

MRT initiatives are actually reducing projected Medicaid growth by billions of dollars. Recent data released by the New York State Department of Health shows that prior to implementation of MRT initiatives, total Medicaid spending for all categories of service was on track to rise exponentially, but the new strategies under MRT have bent the cost curve and resulted in estimated savings of $3.2 billion in New York City alone.

MRT initiatives have proven especially effective in curtailing costs and improving the quality of long term care, which previously had been the cost drivers for most of the growth in the Medicaid program. NYC long term care spending was projected to continue to increase in future years, has instead been projected to result in savings of $980 million.

Medicaid program quality is also on the upswing. The New York State Department of Health 2012 Managed Long Term Care (MLTC) Report found that the overall functional ability of 90 percent of MLTC enrollees has remained stable or improved, 85 percent of MLTC plan members rated their health plan as "good" or "excellent", and 91 percent would recommend their plan to a friend. In addition, a recent study by the National Committee for Quality Assurance (NCQA) analyzed New York State's Medicaid health care plans against 76 different quality measures and found that when it comes to offering the right type of care for costly health factors like diabetes, childhood obesity, smoking cessation and follow-up care for the mentally ill, New York is a national leader, second only to Massachusetts.

About Managed Long Term Care (MLTC):

Mandatory Enrollment in MLTC Plans (MRT 90) calls for the expansion of MLTC for Medicaid recipients who are also eligible for Medicare (dual eligibles) and currently receiving community-based long term care services. Those currently in receipt of community-based long term care services or new users requesting the services will have the option of enrolling in Partial, PACE, or MAP plans. If recipients do not pick a plan, they will be automatically enrolled in Partial Capitation plans because only the Partial plans' benefit package is solely covered by Medicaid. PACE and MAP plans include benefits covered by Medicare, thereby excluding these plans as options for mandatorily enrolled individuals.

The implementation is planned for five phases over the course of at least two years (2012 through 2014) beginning in Manhattan. Managed long-term care assists chronically ill or disabled individuals who require health and long-term care services. MLTC plans receive a monthly risk-adjusted capitation payment from New York State Medicaid to pay for a range of health and social services. The benefit package includes home care, personal care, social supports, and transportation services. The costs of skilled nursing facility services are included in the capitation payment, thereby providing a financial incentive for the plans to keep their members healthy and living in the community. Depending on the type of plan, ambulatory care, inpatient, and mental health services may also be included in the benefit package.

MLTC enrollment has steadily increased over the past eight years from approximately 10,000 in 2004 to nearly 70,000 as of November 2012, with the number of plans growing from 16 plans to 38 plans. Currently, 89 percent of the enrollment is in partial capitation plans and highly concentrated in New York City, which accounts for 93 percent of MLTC enrollment.

About the Medicaid Redesign Team:

Governor Cuomo established the Medicaid Redesign Team (MRT) upon taking office in January 2011, bringing together stakeholders and experts from throughout the state to work cooperatively to reform the system and reduce costs. The collaborative process ensured that the action plan outlined in the MRT report has broad support among the health care stakeholder community. Through this collaborative effort, MRT initiatives have transformed the program into a national model that cut costs, puts the patient first, and creates a sustainable model of growth focused on quality of care. More information on the MRT and its initiatives is available at

NYC Total Medicaid Spending for All Categories of Service Under the Global Spending Cap, (2003-2012)