Statistics on Medicare and Medicaid Managed Care -- Enrollment Numbers and other Data -- New York State

Numbers tell a big part of the story of how managed care plans are doing in providing care.  With mandatory enrollment in Medicaid managed care now required in every county in New York State for most people who do not have Medicare, and mandatory enrollment in Managed Long Term Care of those adults age 21+ who have both Medicare and Medicaid, and who need home care or other long term care, who live in NYC, Long Island, or Westchester, it is important to for the State to monitor how much care the plans are delivering and the quality.  It is also telling to see the growing numbers of people enrolled in various plans, and the new plans joining the competition.   This article compiles some web links and information on enrollment, cost and quality data.   For consumer advocacy calling on the state to improve quality, monitoring and access in MLTC, see Consumer Advocates Call for Further Protections in Medicaid Managed Long Term Care.

Enrollment Numbers in Managed Care Plans in NYS for Dual Eligibles

  1. Medicare Advantage plan enrollment - monthly enrollment available by plan and county in NYS at this CMS link.  
  2. Medicaid Managed Care enrollment - including mainstream Medicaid managed care, Managed Long Term Care & PACE, Mediciad Advantage, and Medicaid Advantage Plus - monthly enrollment data by plan available at this link
  3. The two data sources above - Medicare and Medicaid -- are combined in these comparison charts showing penetration of Medicare Advantage  in each county in NYS with number enrolled in each company's various insurance products -- Medicare Advantage, Medicad Advantage, Medicaid Advantage Plus, PACE, and Managed Long Term Care.   (Not included are mainstream Medicaid Managed care plans)  

Quality and Cost Data - Managed Long Term Care 

MLTC, PACE and MAP plans must file Quarterly Managed Medicaid Cost and Operating Reports (MMCOR) data with the State Department of Health, which includes the medical loss ratio (percentage of premium spent on medical care compared to
administrative expenses), plan spending in different care settings, amount of capitation rate spent on administrative expenses compared to services, the types, level and cost of various services provided to members, the number of members receiving different types of services or no services, and a variety of other elements which should be subject to regression analysis to
determine important correlations.  This data is only available to the public through Freedom of Information requests, and then the electronic data must be converted to a format that can be analyzed.   NYLAG obtained some of this data for 2010 and 2011, but to date has not had the resources to analyze it fully.  Some preliminary analysis includes:  

Mainstream Medicaid Managed Care 

Article ID: 187
Last updated: 24 Apr, 2013
Revision: 4
Medicaid -> Statistics on Medicare and Medicaid Managed Care -- Enrollment Numbers and other Data -- New York State