State DOH Issues Medicaid Global Spending Cap Report for March 2021    

Situation Report | July 20, 2021

The state Department of Health (DOH) has recently issued the latest Medicaid Global Spending Report as of March 2021. It covers April 2020 through March 30, 2021.

In the report, DOH and the state Division of Budget (DOB) report that spending under the Fiscal Year (FY) 2021 Medicaid Global Spending Cap was $6 million below the $19.936 billion target.

The report credits payment deferral actions of $1.7 billion for avoiding price and utilization trends that would have caused spending of $123 million over the cap absent these cash management actions.

Among pressures on the cap is Medicaid enrollment, which increased by 871,936 New Yorkers or 12.5 percent, growing from 6.1 million enrollees in March 2020 to 7 million enrollees as of March 2021. This increase is in large part due to the COVID-19 pandemic and loss of employer-sponsored coverage or changes in income.

Also, this fiscal year included 53 weekly Medicaid payments cycles (versus 52). Because the Global Cap is on a cash basis, the extra cycle payment adds additional costs to the current fiscal year. The 53rd Medicaid Cycle payment resulted in an additional $132 million in costs.

The report also cites a loss of federal funds that drove $450 million in FY 2021 state spending growth: a phase-down of the Affordable Care Act (ACA) enhanced Medicaid shares for single and childless adults.

Any additional federal relief measures (including increased federal Medicaid relief funds) were used to support the significant increase costs of Medicaid enrollment from individuals losing income and/or job-related insurance coverage because of the COVID-19 pandemic.

Other significant highlights include:

  • Mainstream Medicaid Managed Care costs were $286 million less than the global cap target amount.
  • Managed Long Term Care (MLTC) costs were $83 million less than the global cap target amount.
  • Medicaid fee-for-service “Other Long Term Care” (which historically included personal care services) was $14 million less than the global cap target amount.
  • Through the end of March 2021, the state’s Accounts Receivable (AR) balance increased by $15 million.