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

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.    

SEE NYLAG's MLTC DATA TRANSPARENCY PROJECT and REPORT 

• based on the cost reports for 2017 and 2018. 
• Download the Full Report
• Scroll down on the above webpage for the interactive visualizations, showing  where the plans spend the Medicaid premiums they receive from the State and how many hours of care they are providing. 

Medical-Loss Ratio (MLR)

See description of Medical  Loss Ratio 

MLR Reports for each type of managed care plan are posted at this link - scroll down to Medical Loss Ratio reports. 

NYS Dept. of Health Annual MLTC Quality Reports

• At this link https://www.health.ny.gov/health_care/managed_care/mltc/reports.htm  - use the dropdown for "Quality Performance reports."  These annual reports have used the same template since 2013.  At that time, NYLAG joined other organizations to issue a critique of these reports:

  • ​April 5, 2013 - New York’s 2012 Managed Long Term Care Report: An Incomplete Picture

    The Coalition to Protect the Rights of New York’s Dually Eligible issued this "Incomplete Picture" Report as a critique of the NYS Dept. of Health's 2012 Managed Long Term Care Report, issued in December 2012.  The  State's Report does not provide the full spectrum of information that beneficiaries need to make informed health care choices -- For exampe, The 2012 Report presents the most favorable findings of the  MLTC Plan Member Satisfaction Survey Report, but fails to mention less positive but important findings from IPRO’s report, including the fact that higher need respondents in poorer health were significantly more likely to raise concerns about services than those in good health.  The Report fails to include any meaningful utilization data, showing the amount of and type of services provided by MLTC plans or the medical-loss ratios of the various plans.  The Report fails to comply with the Public Health Law that requires the report to  present information  in a way that allows beneficiaries to make meaningful comparison between plans.  Inadequate quality data is reported as well.  

• At the same link, see the dropdown for Statistical Briefs on the MLTC program. 

Managed Care Program Annual Report (MCPAR) 

WHERE:  Managed Care Reports - scroll down to the 2nd last dropdown.  While most NYS DOH reports give program-wide data for plans, not broken down by plan, these new reports that began in 2023 do give specific data for each plan on the numbers and outcome of grievances and appeals, and other key data.   .  

Mainstream Medicaid Managed Care

• NYS Dept. of Health public information on quality -- 

http://www.health.ny.gov/health_care/managed_care/reports/index.htm