Table 1.
Summary of Evaluation Results
| Domain | Goal | Outcome | Result | |
|---|---|---|---|---|
| Domain 1, Component 1: Managed Long-Term Care (MLTC) | Goal 1: Expand access to MLTC for Medicaid enrollees in need of LTSS | RQ1. Time for the MLTC mandate's effect on enrollment to stabilize |
|
19 months, stabilizing at +0.6 percentage points per year; a 12-percentage point increase in enrollment rates during the 79 months post-mandate (p < 0.05) |
| Goal 2: Demonstrate stability or improvement in patient safety | RQ1. Percentage of enrollees who had no emergency room visits |
|
+0.8 percentage points (p > 0.05) | |
| RQ2. Percentage of enrollees who had no falls that required medical intervention or resulted in major or minor injuries |
|
−1.8 percentage points (p > 0.05) | ||
| Goal 3: Demonstrate stability or improvement in quality of care | RQ1. Receipt of timely care |
|
−0.8 percentage points (p > 0.05) | |
| RQ2. Influenza vaccination |
|
+0.2 percentage points (p > 0.05) | ||
| RQ2. Dental exam |
|
−5.6 percentage points (p > 0.05) | ||
| Goal 4: Stabilize or reduce preventable acute hospital admissions | RQ1. Potentially avoidable hospitalizations |
|
−1.3 hospitalizations per 10,000 enrollee days (p > 0.05) | |
| Goal 5: Demonstrate stability or improvement in consumer satisfaction | RQ1. Satisfaction with MLTC plans |
|
−1.8 percentage points (p > 0.05) | |
| RQ2. Satisfaction with care managers |
|
−3.1 percentage points (p < 0.05) | ||
| RQ3. Satisfaction with provider timeliness |
|
−2.2 percentage points (p > 0.05) | ||
| RQ4. Satisfaction with service quality |
|
−1.2 percentage points (p > 0.05) | ||
| Domain 1, Component 2: Individuals Moved from Institutional Settings to Community Settings for LTSS | Goal 1: Improve access to MLTC for those who transitioned from an institutional setting to the community | RQ1. Enrollment in MLTC within one year post-discharge from an institution |
|
7% in 2015; 60% in 2018 (p < 0.05) |
| Goal 2: Demonstrate stability or improvement in patient safety | RQ1. Percentage of enrollees who had no emergency room visits |
|
50% in 2015; 85% in 2018 (p > 0.05) | |
| RQ2. Percentage of enrollees who had no falls that required medical intervention or resulted in major or minor injuries |
|
50% in 2015; 93% in 2018 (p > 0.05) | ||
| Goal 3: Demonstrate stability or improvement in quality of care | RQ1. Percentage in community within one year post-discharge from an institution |
|
85% in 2015; 81% in 2018 (p > 0.05) | |
| RQ2. Influenza vaccination |
|
50% in 2015; 73% in 2018 (p > 0.05) | ||
| RQ2. Dental exam |
|
50% in 2015; 64% in 2018 (p < 0.05) | ||
| Domain 2: Mainstream Medicaid Managed Care and Temporary Assistance to Needy Families (TANF) | Goal 1: Increase access to health insurance through Medicaid enrollment—Express Lane Eligibility | RQ1. Medicaid enrollment, RQ2. demographic characteristics, and RQ3. percentage of ineligible enrollees | Removed from the evaluation | |
| Goal 2: Limit gaps in Medicaid eligibility due to fluctuations in recipient income—12-month continuous eligibility | RQ1: Percentage with at least 12, 24, or 36 months of enrollment among the population affected by the continuous eligibility policy |
|
≥12 months: 47% in 2012; 58% in 2017 (p < 0.01) for NYSoH and 47% in 2012; 58% in 2017 for WMS (p < 0.01)
≥24 months: 23% in 2012, 32% in 2016 (p < 0.01) for NYSoH and 23% in 2012, 34% in 2016 for WMS (p < 0.01) 36 months: 13% in 2012; 18% in 2015 (p < 0.01) for NYSoH and 13% in 2012; 29% in 2015 for WMS (p < 0.01) |
|
| RQ2: Difference in percentage with at least 12, 24, or 36 months of enrollment by enrollee characteristics |
|
Demographics: Older members, White and Hispanic members, and members with a lower health status more likely to have longer enrollment duration for NYSoH and WMS populations (all p < 0.01)
Geographic area: Individuals in New York City had longer enrollment durations that those not in New York City for NYSoH and WMS populations (all p < 0. 01) |
||
| RQ3: Average number of continuous enrollment months |
|
+0.8 and +1.9 months in a 12- and 24-month post-policy period for NYSoH populations, respectively (p < 0.05)
+0.4 and +1.2 months in a 12- and 24-month post-policy period for WMS populations, respectively (p < 0.05) |
||
| RQ4: Probability of being continuously enrolled for at least 12 months |
|
+0.19 probability of being enrolled for the NYSoH population (p < 0.05)
+0.14 probability of being enrolled for the WMS population (p < 0.05) |
||
| RQ5: Effect of the continuous eligibility policy on outpatient, inpatient, and emergency department visits and Medicaid cost of care |
|
Utilization: −43 inpatient admissions, −295 outpatient visits, and −49 emergency room visits per 1,000 member-years for the NYSoH population (all p < 0.05)
−29 inpatient admissions (p < 0.05), +101 outpatient visits (p < 0.05), and +17 emergency room visits per 1,000 member-years for the WMS population (p > 0.05) Medicaid cost: −$27 per member per month for the NYSoH population (p < 0.05), −$8 per member per month for the WMS population (p > 0.05) |
||
| RQ6: Increased number of enrollment months due to the continuous eligibility policy |
|
+378k (p < 0.05), +1,030k (p < 0.05), +959k (p < 0.05), +1,046k (p < 0.05) enrollees for 2014–2017, respectively, for the NYSoH population
+530k (p < 0.05), +483k (p > 0.05) enrollees for 2016–2017, respectively, for the WMS population |
||
| RQ7: Percentage of individuals in fee for service (FFS) by calendar month |
|
29% in January 2012; 23% in December 2018 (p < 0.01) | ||
| RQ8: Percentage in FFS for 1–2 months, among those with any MMC coverage in a year |
|
All enrollees: 18% in 2012; 19% in 2018 (p < 0.01)
New enrollees: 25% in 2012; 36% in 2018 (p < 0.01) NYSoH enrollees: 74% in 2014; 27% in 2018 (p < 0.01) WMS enrollees: 8% in 2014; 6% in 2018 (p < 0.01) |
||
| RQ8: FFS enrollment months in the first enrollment year, among those with at least 6 months of MMC coverage in that year |
|
−0.6 months of FFS enrollment during the first enrollment year (p < 0.01) | ||
| RQ9: Percentage of MMC enrollees remaining in the same MMC plan after the recertification, among those with at least 13 consecutive months of MMC coverage |
|
All enrollees: 88% in 2013; 80% in 2018 (p < 0.01)
NYSoH enrollees: 70% in 2014; 77% in 2018 (p < 0.01) WMS enrollees: 93% in 2014; 90% in 2018 (p < 0.01) |
||
| RQ10: Percentage of MMC enrollees who are auto-assigned to any health plan at the start of MMC enrollment |
|
All enrollees: 6.6% in 2012; 4.4% in 2018 (p < 0.01)
NYSoH enrollees: ~0% in 2014; 2.7% in 2018 (p < 0.01) WMS enrollees: 5.6% in 2014; 8.5% in 2018 (p < 0.01) |
||
NOTE: RQ = research question. The color code: green represents favorable results, red unfavorable, and yellow neither. For Domain 1, Component 2, since no pre-MLTC mandate data were available, only the post-period trends are presented. Due to a large sample size of about 1 to 6 million individuals, the descriptive trend tests for Domain 2, Goal 2, RQs 7–10 result in small p values.