Expanding Health Care Coverage

Project Title

Streamlining Medicaid Spend Down

Grant Amount

$48,204

Priority Area

Expanding Health Care Coverage

Date Awarded

January 18, 2008

Region

NYC

Status

Closed

Website

http://www.manatt.com/

The Medicaid Excess Income program is an optional Federal program that allows individuals with large or ongoing medical expenses access to Medicaid coverage, even though their household income is too high to meet the regular Medicaid income eligibility standards. Individuals “spend down” by paying in or incurring medical expenses that equal or exceed the difference between their monthly income and the Medicaid eligibility level. However, Local Departments of Social Service (Local Districts) responsible for gathering health care receipts and payments and tracking these enrollees’ continued eligibility are struggling to manage the eligibility of Medicaid recipients enrolled in the Excess Income program. Under this grant, Manatt Health Solutions (Manatt) analyzed the Excess Income Program in New York State, and identified ways to improve the administrative efficiency and programmatic implementation of its enrollment and eligibility processes. The results of this report galvanized the consumer advocacy community to use the report as leverage to push for reforms of the Excess Income program.

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

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

Read Streamlining New York’s Medicaid Excess Income Program, a public report produced by Manatt about the Excess Income program, complete with a description of the program, characteristics and health care needs of enrollees, and options for streamlining the program.

One of the reports’ recommendations, which the New York State Department of Health’s Office of Health Insurance Programs has implemented, is the establishment of a new Statewide Enrollment Center for Medicaid to centralize and streamline enrollment and renewal tasks across its public health insurance programs.

The Medicaid Excess Income program is an optional Federal program that allows individuals with large or ongoing medical expenses access to Medicaid coverage, even though their household income is too high to meet the regular Medicaid income eligibility standards. Individuals “spend down” by paying in or incurring medical expenses that equal or exceed the difference between their monthly income and the Medicaid eligibility level. However, Local Departments of Social Service (Local Districts) responsible for gathering health care receipts and payments and tracking these enrollees’ continued eligibility are struggling to manage the eligibility of Medicaid recipients enrolled in the Excess Income program. Under this grant, Manatt Health Solutions (Manatt) will analyze the Excess Income Program in New York State and identify ways to improve the administrative efficiency and programmatic implementation of its enrollment and eligibility processes.

Manatt’s grant activities will include: 1) analyzing data indicating the size and characteristics of the Excess Income populations; 2) conducting interviews with Local Districts, consumer advocates, and Medicaid providers serving Excess Income recipients to gather more detailed information about the current process; 3) performing an Excess Income “landscape scan” to identify best practices in the area; 4) examining variations in how Local Districts within New York administer the Excess Income program; and 5) outlining several options for restructuring the Excess Income enrollment and eligibility process.