Barclay Damon
Barclay Damon

Legal Alert

State Assuming Medicaid Administration From Counties and New York City

In New York, the federal and state governments, counties and the City of New York all contribute shares of the costs of the Medicaid program. Counties and the City of New York also have an integral role in beneficiary enrollment and in the administration of various components of the Medicaid program. To relieve county governments and the City of New York of the increasing burden on local taxes due to escalating Medicaid costs, the state, beginning in 2006, has capped the local shares at fixed percentage increases over 2005 expenditures, with the state assuming the additional costs of the non-federal share.

The state is now proceeding with its next steps and is proposing to take over both beneficiary enrollment and administration of the Medicaid program from local governments. A report issued by the Department of Health, as required by legislation enacted in this past session, outlines the process for state assumption of these roles and responsibilities. Much of the report focuses on phasing-in state assumption of the beneficiary enrollment process to a more centralized administration in preparation for the expansion of the Medicaid program in 2014 under federal health care reform.

The report also addresses centralizing administration in the state from local government in the following areas:

  • administration of managed care beneficiary enrollment and managed care contracts by the Department of Health;
  • arranging and managing non-emergency transportation services through phasing in the use of regional transportation brokers under contracts with the Department of Health;
  • transfer requests for prior authorization review of orthodontic services from New York City to the Department of Health to consolidate the process currently applicable in the rest of the state; and
  • transition administration of components of long-term care services to the Department of Health for:
    • personal care services contracting and authorization;
    • private duty nursing authorization;
    • long-term care waiver programs assessment and authorization; and
    • managed long-term care assessment review and enrollment.

The report recommends further analysis of local governments’ role in Medicaid program integrity activities and estate and insurance recoveries.

The Report concludes with charts and diagrams of the Medicaid program and a preliminary implementation schedule for these initiatives. The full report is available at http://www.health.ny.gov/health_care/docs/2010-11_medicaid_admin_report.pdf.

For further information contact Eugene M. Laks or any member of our Health Care and Human Services Practice Area.