NYAPRS Note: A new chart released by the Office of the State Comptroller indicates the breadth of state Medicaid Managed Care contracts, below. As this brief article highlights from Crain’s and as we indicated last week regarding the new CMS Medicaid managed care rules, there are unlikely to be any significant changes to the structure and regulation of plans in NY, but plan in other states will likely have to trim administrative finances to meet the new medical loss ratio standard.
Managed Care Changes, Contracts
Crain’s Health Pulse; 6/1/2015
CMS released proposed changes to Medicaid managed care last week, but they aren’t expected to shake things up in New York, according to the New York Health Plan Association. The state recently approved new five-year agreements for 16 Medicaid managed care plans that serve 4.6 million people. *See the full list below* Among the proposed rules, plans would be subject to an 85% medical-loss ratio by 2017, as well as network adequacy standards and quality measures that align with the ACA marketplace and Medicare Advantage plans. New York plans are already subject to an administrative cost cap of $28.90 per member per month, which HPA believes will be below the 15% threshold, according to a spokeswoman. The state already requires quality reporting and network adequacy for these types of plans. “New York is pretty much ahead of the CMS proposals,” the spokeswoman said.
|
Plan Name |
Contract Amount |
Total State Enrollment as of May 2015 |
|
Healthfirst |
$24,448,378,431.00 |
939,085 |
|
NYS Catholic Health Plan |
$22,588,614,865.00 |
1,104,010 |
|
MetroPlus |
$14,420,668,628.00 |
422,706 |
|
AmeriGroup |
$11,570,208,855.00 |
410,214 |
|
United HealthCare |
$9,655,701,364.00 |
465,261 |
|
Affinity |
$7,664,608,485.00 |
264,254 |
|
Excellus |
$5,428,286,629.00 |
179,427 |
|
Hudson Health Plan |
$3,656,153,311.00 |
152,822 |
|
CDPHP |
$2,406,163,308.00 |
99,654 |
|
WellCare |
$2,295,490,819.00 |
105,917 |
|
Amida Care |
$1,934,974,017.00 |
5,997 |
|
HealthNow |
$1,674,013,582.00 |
31,744 |
|
Independent Health Association |
$1,606,202,706.00 |
72,514 |
|
Univera Community Health |
$1,356,753,519.00 |
50,434 |
|
MVP Health Plan |
$1,150,194,444.00 |
29,709 |
|
Today’s Options |
$996,972,696.00 |
38,445 |
Source: Office of the State Comptroller