Department of Civil Service

New York State Health Insurance Program: Coordination of Medicare Coverage for Mental Health and Substance Abuse Services in 2001

In the New York State Health Insurance Program, the Department of Civil Service administers health insurance programs for active and retired State and local government employees and their dependents. The primary such program is the Empire Plan, which provides services costing more than $2.5 billion a year.

Medicare is a federal health insurance program for disabled people and people aged 65 or older. When Empire Plan enrollees become eligible for Medicare, their medical expenses should generally be paid by Medicare. We examined the claims paid during the year 2001 for mental health services and substance abuse services by the Empire Plan on behalf of people who were eligible for Medicare and determined that $410,233 of these claims should have been paid by Medicare. We recommended that these payments be recovered, and improvements made in the Empire Plan's procedures for identifying enrollees who are eligible for Medicare.

For a complete copy of Report 2002-S-10 click here.
For a copy of the 90-day response click here.