Research Questions

  1. Has the MLTC program expanded access to long-term services and supports and improved patient safety, quality of care, and consumer satisfaction in New York State?
  2. Has the 12-month continuous eligibility policy reduced enrollment gaps and increased Medicaid enrollment duration in New York State?

The broad goals of New York State's Medicaid Section 1115 Waiver are to enroll a majority of Medicaid beneficiaries into managed care, increase access and service quality, and expand coverage to more low-income New Yorkers. The RAND Corporation was competitively selected as the independent evaluator to assess two components under this 1115 Demonstration Waiver: the Managed Long-Term Care (MLTC) program and the 12-month continuous eligibility policy, which guarantees enrollees Medicaid coverage regardless of changes in income in the 12 months after eligibility determination and enrollment. This final interim evaluation report examines whether these two components have helped achieve the program's goals.

The RAND team's analyses show that the Demonstration has expanded access to managed care through mandatory MLTC enrollment and 12-month continuous eligibility. The team found no evidence of a significant change in patient safety or quality of care. The authors note that, although this means that there is no evidence the Demonstration achieved the goal of improving quality of care, increasing access without compromising quality of care is a success in its own right.

Key Findings

The MLTC program under the 1115 Demonstration Waiver has achieved its goal of increasing access to long-term services and supports

  • The MLTC mandate was associated with a large increase in MLTC enrollment during 2012–2018, with its effect stabilizing after 19 months.
  • There is no evidence of a decline in patient safety, quality of care, or consumer satisfaction, except for a decrease in satisfaction with care managers.
  • Among those who transitioned from institutional settings to community settings, enrollment in MLTC increased during 2015–2018, but no statistically significant changes in patient safety and quality of care were observed except for an increase in receipt of dental exams.

The 12-month continuous eligibility policy was associated with a moderate increase in Medicaid enrollment duration

  • The 12-month continuous eligibility policy was associated with statistically significant increases in enrollment duration and outpatient visits, but decreases in inpatient admissions and per member per month Medicaid cost.
  • When considering both increases in enrollment and decreases in per member per month Medicaid cost, the policy is associated with a net increase in total Medicaid cost. From 2012 through 2018, descriptive trends show that New York State has been able to reduce the length of fee-for-service enrollment among Medicaid managed care enrollees.

Research conducted by

This research was funded by the New York State Department of Health and carried out within the Payment, Cost, and Coverage Program in RAND Health Care.

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