Global Cap Update

Expenditures subject to the state's Medicaid Global Spending Cap were $29 million below projections through August 2013.  The state reports that five months into the current fiscal year, spending was 0.4 percent lower than expected despite Medicaid enrollment growth of 2.2 percent (115,194 additional enrollees).  The SFY 2013-14 state budget provided for a $510 million dollar increase in the cap over the previous year, most of which is earmarked for various provider rate updates and managed care plan premium adjustments, many with retroactive effective dates. 

Nursing home spending was as projected while other long term care Medicaid expenditures were trending $24 million below projections.  Overall fee-for-service spending was $40 million below projections, while Medicaid managed care expenditures were $39 million higher than expected.  The state observed that the movement of downstate community-based long term care recipients into managed care had significantly reduced average Medicaid rates, while managed long term care enrollment was roughly 1,500 enrollees higher than expected.     

When compared to the same five month period one year ago, the number of nursing home claims decreased in all regions of the state except the Buffalo region, the Southern Tier and the Mohawk Valley.  Of the projected 40,000 dual eligible Medicaid enrollees in need of community-based long term care services targeted for managed care enrollment in New York City, Long Island and Westchester County, approximately 25,000 have enrolled to date.

The Medicaid Global Spending Cap Report for August 2013 is posted here.  Regional reports are available here. 

Contact:  Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841