Department of Health

Assessing Medicaid Managed Care Provider Networks

At the time of our audit, about 625,000 of New York's Medicaid recipients were enrolled in managed care organizations. As part of an initiative that was begun late in 1997, the Department of Health plans to enroll a total of 2.4 million Medicaid recipients in such organizations by December 31, 2000. To help determine whether Medicaid managed care coverage can be extended as planned, we examined the Department's process for determining the maximum number of Medicaid recipients that can be served by a managed care organization without compromising the quality of the services provided. We found that, while the Department routinely assesses the capacity of the managed care organizations serving Medicaid recipients, these assessments do not consider the number of non-Medicaid patients who are enrolled in each organization, and do not fully consider whether a managed care organization's primary care providers are easily accessible to their patients. If these factors are not taken into account when managed care coverage is extended to additional Medicaid recipients, the quality of the care provided to some of the recipients may be jeopardized by excessive patient caseloads and difficult-to-access health care providers.

For a complete copy of Report 97-S-59 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.