Enhanced Federal Funding Helps Lower State and Local Medicaid Spending; Overall Spending Decreases Slightly

• Enhanced federal Medicaid funding during the pandemic helped lower State Medicaid spending by $4.1 billion (15.4 percent) to $22.5 billion and local Medicaid spending by $693 million (8.3 percent) to $7.7 billion in SFY 2020-21. Federal COVID relief legislation shifted $3.4 billion in State Medicaid costs and $754 million in local Medicaid costs to the federal government. Compared to the year before, combined local, State and federal Medicaid spending decreased by $650 million (0.9 percent) to $75.2 billion in SFY 2020-21. State share spending is further influenced by the continued deferral of certain Medicaid payments with a State share total of $1.7 billion from SFY 2020-21 to SFY 2021-22, which according to the Division of the Budget was necessary to ensure compliance with the global cap limit for SFY 2020-21.

Pandemic Brings Jump in Medicaid Enrollment

• Department of Health (DOH) Medicaid enrollment rose by 521,805 (8.4 percent) to 6.7 million in SFY 2020-21 during the COVID-19 pandemic, the largest overall and percentage increases in average monthly enrollment since SFY 2014-15. According to DOH data, in February 2021, enrollment surpassed 7 million for the first time in the history of the program, with 7,021,739 enrollees. The Division of the Budget expects current year enrollment to exceed 7.1 million in March 2022, largely due to federal provisions banning states from terminating coverage and requiring one-year extensions of eligibility during the public health emergency.
• Children and adults represented 75.5 percent of all average monthly DOH Medicaid enrollees, but only 41.2 percent of the costs of DOH Medicaid claims for the State in SFY 2020-21. Elderly, blind, and disabled enrollees made up 20.2 percent of eligible recipients, but accounted for 55.6 percent of DOH Medicaid claims costs.

Pandemic Boosts Essential Plan Enrollment

• Enrollment in the Essential Plan, which began in SFY 2015-16 and rose to more than 728,000 over its first three years, increased by 11.4 percent, its fastest rate in four years, to 891,932, largely due to the pandemic-induced recession. The Division of the Budget expects enrollment to grow by nearly 71,000 individuals (8.0 percent) to nearly 963,000 in SFY 2021-22.
• 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 Affordable Care Act (ACA) and largely funded by the federal government. In New York, the program is known as the Essential Plan. It is available to individuals who are under 65, not eligible for Medicaid or the Child Health Plus (CHP) Program, without access to affordable coverage and with incomes at or below 200 percent of poverty level.
• Spending on the Essential Plan increased by $696 million (17.8 percent) to $4.6 billion. In SFY 2020-21, federal funds covered 98.6 percent or $4.5 billion in Essential Plan costs, with State funds covering the remaining 1.4 percent.

Nearly 8.4 Million New Yorkers Benefit from DOH Medicaid, Essential Plan or Child Health Plus

• In March 2021, nearly 8.4 million individuals or more than two in five New Yorkers were enrolled in DOH Medicaid, the Essential Plan or CHP.