Poster #75 - New York State Medicaid Managed Care Database (2010-2021)

• In Event: Friday Poster Reception

Abstract

Background: Medicaid managed care's financial operations are less transparent than fee-for-service, despite insurers' significant influence on healthcare for Medicaid beneficiaries. This paper details the creation of a publicly accessible database of New York State Medicaid plans from 2010 to 2021. This resource offers unique county and statewide insights into NYS Medicaid expenditures, revenues, and member demographics. It also presents opportunities to link this data with other public datasets to analyze insurer-provider dynamics across various healthcare settings.

Objective: To establish a free, public database enabling individuals, researchers, and governments to understand Medicaid plan operations and costs in New York State.

Methods: We submitted Freedom of Information Law (FOIL) requests in 2023 to the New York State Department of Health for Managed Medicaid Cost and Operating Reports (MMCOR) from all Medicaid Managed Care Plans (2010-2022), encompassing reports for each service area and statewide filings. Received PDF files were converted to XLSX format. For 2015-2021 PDFs, Adobe Acrobat Pro was used. Earlier PDFs (2010-2014), being images of spreadsheets, required conversion via pdf24 Creator. Enrollment data was cross-verified with state publications. We also gathered market data on each firm (profit status, public trading status) to assess reporting variations based on firm characteristics. Annual reporting data for all plans was compiled into yearly files for analysis.

Results: Current analyses cover 2017-2021 data, including reported revenues and expenses by care site, and visit counts for non-dual, non-special needs Medicaid enrollees in New York State. Enrollment counts aligned with state figures at ≥99.0%. The market includes both non-profit and for-profit entities. Ongoing analyses compare average expenses by care site over time and member characteristics by firm profit status.

Conclusions/Implications: While some entities charge for similar data, our aim is a free, comprehensive database (2010-2021) for public insight into NYS Medicaid plan practices. Its public availability facilitates connections with other datasets and the linking of state policies to per-member-per-month costs. Despite managing over 80% of national Medicaid beneficiaries, Medicaid insurers' operations have largely been opaque. This database enables crucial evaluation for informed regulation and legislation.

Author

• Ashley L Hopkins, University of California - Los Angeles
  Presenting Author