Streamlining Medicaid Spend DownThe Medicaid Excess Income program is an optional Federal program that allows individuals with large or ongoing medical expenses access to Medicaid coverage, even though their household income is too high to meet the regular Medicaid income eligibility standards.
Manatt Health Solutions
Expanding Health Care Coverage
January 16, 2008 – April 9, 2009
The Medicaid Excess Income program is an optional Federal program that allows individuals with large or ongoing medical expenses access to Medicaid coverage, even though their household income is too high to meet the regular Medicaid income eligibility standards. Individuals “spend down” by paying in or incurring medical expenses that equal or exceed the difference between their monthly income and the Medicaid eligibility level. However, Local Departments of Social Service (Local Districts) responsible for gathering health care receipts and payments and tracking these enrollees’ continued eligibility are struggling to manage the eligibility of Medicaid recipients enrolled in the Excess Income program. Under this grant, Manatt Health Solutions (Manatt) analyzed the Excess Income Program in New York State, and identified ways to improve the administrative efficiency and programmatic implementation of its enrollment and eligibility processes. The results of this report galvanized the consumer advocacy community to use the report as leverage to push for reforms of the Excess Income program.
This project was part of a larger NYHealth authorization that funded a series of quick-strike analyses to help the New York State Department of Health’s Office of Health Insurance Programs find ways to streamline and expand its public health insurance programs.
Read an NYHealth special report that contains a summary of findings from this authorization.
Read Streamlining New York’s Medicaid Excess Income Program, a public report produced by Manatt about the Excess Income program, complete with a description of the program, characteristics and health care needs of enrollees, and options for streamlining the program.
One of the reports’ recommendations, which the New York State Department of Health’s Office of Health Insurance Programs has implemented, is the establishment of a new Statewide Enrollment Center for Medicaid to centralize and streamline enrollment and renewal tasks across its public health insurance programs.
Outcomes and Lessons Learned
- Conducted research on State and Federal administrative guidance, statutes, and regulations regarding both the existing program and alternative approaches.
- Worked in partnership with OHIP to analyze its data on the number and characteristics of the Medicaid Excess Income participants.
- Interviewed approximately 15 organizations/entities about the current eligibility process, including timelines, procedures, and the specific scope and nature of the challenges.
- Performed a Medicaid Excess Income “landscape scan.”
- Identified significant regional variation in how Local Districts within New York administered the Excess Income program.
- Developed options for restructuring the Medicaid Excess Income enrollment and eligibility process.
- Produced a public report on the Excess Income program.