Reimbursement Reform and Cost Management Project

A large share of Medicaid costs can be attributed to spending on patients with serious and/or chronic illnesses.

While the State has sought to improve the care of chronically ill patients through implementing a managed care program, approximately 25% of Medicaid beneficiaries still remain in the unmanaged fee-for-service (FFS) program. Many of these managed care exempt and excluded beneficiaries are among the most seriously medically ill and often have behavioral health co-morbidities. Under this grant, John Billings of New York University’s Robert F. Wagner Graduate School of Public Service (NYU Wagner) assisted the New York State Department of Health’s Office of Health Insurance Programs (OHIP) to develop and implement the Chronic Illness Demonstration Project (CIDP), an approximately $30 million initiative to improve health outcomes and contain the cost of caring for a subset of these vulnerable FFS Medicaid beneficiaries. This grant helped to provide key analytics to inform a large State investment in testing better and less costly models of care for Medicaid’s highest-need beneficiaries.

This project was part of a larger NYHealth authorization that funded a series of quick-strike analyses to help the New York State Department of Health’s (NYSDOH’s) Office of Health Insurance Programs find ways to streamline and expand its public health insurance programs.

Read an NYHealth special report that contains a summary of findings from this authorization.