Department of Health

Enrollment of Medicaid Recipients in Managed Care Plans in New York City

In 1997, enrollment in a managed care plan became mandatory for most Medicaid recipients in New York State. To facilitate the mandatory enrollment process in New York City, the Department contracted with an enrollment broker (Maximus Inc). We examined the Departmentís oversight of this contractor and found that improvements were needed.

For example, it is generally not cost-effective for the State if dual eligible recipients (i.e., eligible for both Medicaid and Medicare) are enrolled in Medicaid managed care plans. However, we determined that, for the four years covered by our audit, 11,202 dual eligible recipients were inappropriately enrolled in Medicaid managed care plans. As a result, the Department paid $46.3 million for managed care insurance coverage that was not needed. We recommended that controls be established to disenroll these recipients and prevent the enrollment of such recipients in the future. We also determined that certain actions could be taken by the Department to enhance the enrollment efforts of the contractor, improve the accuracy of the Departmentís managed care enrollment statistics, and obtain information about the recipientsí satisfaction with the services provided by the contractor.

For a complete copy of Report 2002-S-11 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.