Department of Health Medicaid Enrollment Ticks Up by Less Than One Percent

• Average monthly Department of Health (DOH) Medicaid enrollment exceeded 6.1 million in SFY 2017-18, an increase of 19,017, or 0.3 percent, compared to the prior year. The increase reflects higher enrollment among the elderly and “other” eligible recipients (primarily persons who were not born in the U.S. and who are not naturalized citizens), offset in part by lower enrollment among children, adults, and the blind and disabled.
• Compared to the prior year, average monthly DOH Medicaid enrollment for:
  • Adults decreased by 10,256 (0.4 percent) to nearly 2.5 million, accounting for the largest decrease in enrollment;
  • Children with Medicaid coverage decreased by 7,492 (0.3 percent) to nearly 2.2 million;
  • Elderly recipients increased by 22,971 (3.8 percent) to 622,894;
  • Blind or disabled recipients decreased by 4,577 (0.7 percent) to 688,172; and
  • Other eligible recipients increased by 18,372 (11.2 percent) to 182,947.
• DOH Medicaid recipients enrolled in managed care plans at the end of March 2018 increased by 102,402 (2.2 percent) to over 4.7 million, or 77.3 percent of all recipients, compared to March 2017. This increase reflects the continued enrollment of most new recipients into managed care plans and the continued transition of certain populations from fee-for-service to Medicaid managed care.

Medicaid Spending Increases, Largely Due to Additional Federal Payments from the Federal Affordable Care Act (ACA)

• Compared to the year before, combined local, State and federal Medicaid spending increased by $3.6 billion (5.5 percent) to $69.4 billion in SFY 2017-18. This increase largely reflects additional federal Medicaid payments, most of which are associated with the ACA.
• Children and adults represented 75.7 percent of all average monthly DOH Medicaid enrollees, but only 41.7 percent of the costs of DOH Medicaid claims for the State in SFY 2017-18. Elderly, blind and disabled enrollees made up 21.3 percent of eligible recipients, but accounted for 55.9 percent of DOH Medicaid claims costs.

The Essential Plan Continues to Grow

• In SFY 2017-18, enrollment in the Essential Plan averaged 728,807, an increase of 54,329 (8.1 percent) over the prior year.
• In 2015, New York State joined Minnesota to become the only states in the nation to establish a Basic Health Program, a new low-cost health insurance option authorized by the ACA and largely funded by the federal government. In New York State, the Basic Health Program is known as the Essential Plan.
• The Essential Plan is available to individuals who are under 65, not eligible for Medicaid or the Child Health Plus Program, without access to affordable coverage and with incomes at or below 200 percent of poverty.
• In SFY 2017-18, federal funds covered 97.8 percent of nearly $4.0 billion in Essential Plan costs, with State funds covering the remaining 2.2 percent. Individuals with incomes greater than 150 percent but at or below 200 percent of poverty pay $20 monthly premiums to private health plans participating in the program. Individuals with incomes at or below 150 percent of poverty have no monthly premium.
• All participating health plans cover inpatient and outpatient care, physician services, diagnostic services and prescription drugs with low out-of-pocket costs and no annual deductible. Enrollees have no out-of-pocket costs for preventive care, including routine office visits and recommended screenings.