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July Medicaid Global Cap Report: Spending $4M Under Projections

The state Department of Health (DOH) has yet again issued its monthly Medicaid Global Cap report. This latest report, for July, covers the period ending July 31 and beginning at the start of the fiscal year: on April 1.

It finds that overall spending for this period was $4 million below Medicaid Global Cap projections, across all sectors, a difference of $5.984 billion in actual spending versus $5.988 billion in estimated spending for the four-month period. 

The category that includes home care (“Other Long Term Care”) was $22 million over projections, a difference between actual spending of $236 million versus projected spending of $214 million “as a result of more recipients billed than anticipated in personal care, 7 percent. This likely reflects a slower than expected transition to Long Term Managed Care.”

Medicaid Managed Care was $38 million over projections, a difference of $4.163 billion (actual spending) versus $4.125 (estimated spending). The report refers to “slightly higher than expected billed claims through July, which appears to be timing related” under Mainstream Managed Care, which was $30 million over projections while MLTC “was on target with estimates,” though slightly over projection, by $8 million.

The report contains several charts and appendices related to spending across sectors, Medicaid enrollment figures and accounts receivable.

You can read the report at http://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/sfy_2015-2016/docs/july_2015_report.pdf.

HCA is surveying these reports carefully in an information gathering effort, combined with other data analysis, related to home care’s performance under the Global Cap. The cap is accompanied by statutory “super powers” which allow the state to make rate and payment decisions, across-the-board or in a specific sector, to keep spending within projections.

The Medicaid Global Cap for the current fiscal year (April 1, 2015 to March 31, 2016) is $17.7 billion for all sectors.

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