Department of Health

Monitoring Medicaid Managed Care Contracts

Many of New York's Medicaid recipients are enrolled in managed care programs. The managed care providers are required to submit a number of reports to the Department of Health and the appropriate local social service districts. These reports, which relate to various aspects of the medical care provided to the Medicaid recipients, are to be monitored by the Department and the local districts to ensure that the recipients receive access to quality care. We examined the adequacy of the monitoring performed by the Department and selected local districts. We found that improvements are needed, especially at certain of the local districts, as the districts failed to obtain a number of required reports during the period we reviewed, and may not have adequately reviewed the reports that were obtained.

For a complete copy of Report 99-S-15 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.