GAO Report: Medicaid Managed Care Utilization

The U.S. Government Accountability Office (GAO) has issued a report on Medicaid: Service Utilization Patterns for Beneficiaries in Managed Care that analyzes 2010 encounter data reported across 19 states.  The GAO is an independent, nonpartisan agency headed by the United States Comptroller General.   GAO undertook this study at the request of the Senate Finance Committee.  New York was among the 19 states included in the study.

The study found that the number of professional services utilized by adult beneficiaries ranged from about 13 to 55 and for children ranged from about 6 to 16 among.  Overall and on several of the break out measures New York appears to be doing well in terms of managing utilization.  For example, Table 3: Adult Professional Service Utilization in Selected States, 2010 (Source: page 30 of GAO study) lists New York at 18 managed care services per enrollee with a group median at 23 and as noted a range of 13 to 55.  Texas is an extreme outlier at 55.

The study further segregates the data along the lines of adults and children, professional and ancillary services, partial and full-year enrollees, and correlation with related procedure codes.  Again, based on the data New York seemed to be effectively managing utilization within this peer group of states.   It is important to note that this is based on 2010 data, which predates the bulk of the recent managed care expansion.  It will be interesting to see how the data continues to evolve as our State’s Medicaid managed care program continues to expand in terms of both the number or enrollees and the different populations being covered.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827