Department of Health

Enrollment of Medicaid Recipients in Managed Care Plans in New York City (Follow-Up Report)

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 of Health contracted with an enrollment broker (Maximus Inc). In our initial audit report 2002-S-11, we examined the Departmentís oversight of the enrollment process in New York City. We found that, because a number of recipients were needlessly enrolled in Medicaid managed care plans (the recipients were eligible for federally funded Medicare coverage), New York State needlessly paid $46.3 million for managed care insurance coverage during our four-year audit period. We recommended that controls be established to 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. When we followed up on these matters with Department officials, we found that most of our audit recommendations had been implemented.

For a complete copy of Report 2004-F-37 click here.
For a copy of the 90-day response click here.