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HARP AND NON HARPMEDICAID DATABehavioral Health Workgroup MeetingMay 1, 2013Albany, NYMay 1, 2013New York State Department of Health
CY 2011 Medicaid SpendHARP/Non-HARP Populations2Summary of analysis for HARP and Non-HARP population during CY 2011Datasource : Salient and 830486 1,876MLTC eligible178 8,819,9492,101 4,1984,123 97,031,65245,458 2,135143,700 4,003,247,1931,587,578 2,522366,064 6,205,063,3643,914,944 1,585MLTC enrolled6,309 106,640,45575,368 1,415MLTC eligible25,096 1,194,825,146296,156 4,034All other Duals154,224 6,126,307,4481,750,217 3,500551,693 13,632,836,4136,036,685 2,258505,422 10,101,547,1265,454,477 1,852TotalNon-DualsDuals1,539,533 Non-DualsTotal (HARP 39,358 EligibleMonthsMLTC enrolledAll other DualsNON-HARP*ExpenditureMLTC enrolled6,350 107,552,28575,854 1,418MLTC eligible25,274 1,203,645,095298,257 4,036All other Duals158,347 6,223,339,1001,795,675 3,466695,393 17,636,083,6067,624,263 2,313Total* Members not meeting HARP special needs criteria but having OMH or OASAS diagnosis and/or service in CY2011.
OMH, OASAS, Co-Occurring Population Mix3HARP Including DualsOMHOASASCo-OccurringNon-HARP Including DualsOMHOASASCo-Occurring
Non Duals 2011 Medicaid Service SpendHARP/Non-HARP4HARP Service 000200,000,0000MC Amount PaidFFS Amount PaidNON HARP Service Spend 1,600,000,000 1,400,000,000 1,200,000,000 1,000,000,000 800,000,000 600,000,000 400,000,000 200,000,000 -MC Amount PaidFFS Amount Paid
Non Duals 2011 Service Spend per RecipientHARP/Non-HARP5HARP Service Spend per Recipient 60,000 50,000 40,000 30,000 20,000MC Amount Paid perRecipientFFS Amount Paid perRecipient 10,000 -NON HARP Service Spend perRecipient 60,000 50,000 40,000 30,000 20,000 10,000 -MC Amount Paid perRecipientFFS Amount Paid perRecipient
Non HARP Non Duals 2011 Spend BreakoutNH/RTF/Hospice Category6FFS and MC NH/RTF/Hospice SpendSkilled NursingResidential Treatment FacilityDay CareHospiceOther
Non HARP Non Duals 2011 Spend BreakoutMC Home Health/CM/Rehab Category7FFS and MC Home Health/CM/Rehab SpendOPWDD Waiver ServicesOMH Rehab ServicesCase ManagementHome CareDMEOther
Race and Ethnicity Comparison HARP/Non-HARP*8HARP1% 2%American Indian or AlaskanNativeAsian31%43%Black or African AmericanHispanic or LatinoNative Hawaiian or PacificIslanderOther15%White1%8%3%Non-HARPAmerican Indian or Alaskan Native0%Asian30%44%Black or African AmericanHispanic or LatinoNative Hawaiian or Pacific Islander12%10%White0%* Whites may be overstated and Hispanic/Latino understated (under review)Other
Age Comparison HARP/Non-HARP9HARP0 - 2021 - 6465 AND OVERNon-HARP0 - 2021 - 6465 AND OVER
Gender Comparison le57%Male
CY 2011 Top 20 Health Plans – HARP/non-HARP11Plan NameFIDELISHEALTH FIRST PHSP INCMETROPLUS HEALTH PLAN INCAFFINITY HEALTH PLAN INCHEALTH PLUS PHSP INCBLUE CHOICE/BLUE CHOICE OPTIOUNITED HEALTHCARE OF NY INCHLTH INSURANCE PLAN OF GTR NYNEIGHBHD HLTH PROVIDER PHSPHUDSON HEALTH PLAN INCCAPITAL DISTRICT PHYS HLTH PLHEALTHNOW NY INCSYRACUSE PHSPINDEPENDENT HLTH ASSOCIATIONMVP HEALTH PLAN, INCAMERIGROUP NEW YORK LLCBUFFALO COMMUNITY HEALTH INCWELLCARE OF NEW YORK INCUB FAMILY MEDICINENY PRESBY SYS SELECT HLTH SNHARP 1,7641,7701,4721,466
CY 2011 OMH and OASAS Service SpendHARP Population12HARP OMH and OASAS Services Spend 300,000,000 250,000,000 200,000,000 150,000,000 100,000,000 50,000,000 0FFS Amount PaidMC Amount Paid
CY 2011 OMH and OASAS Service SpendNon-HARP Population13Non-HARP OMH and OASAS Services Spend 300,000,000 250,000,000 200,000,000 150,000,000 100,000,000 50,000,000 0FFS Amount PaidMC Amount Paid
Non-Duals 2011 HARP Spending Trend14HARP Billing Trend600,000,000500,000,000400,000,000FFS Drugs Amt Paid300,000,000MC Drugs Amt Paid200,000,000100,000,000FFS & MC Amt Paid(excluding drugs)0Non-HARP Billing Trend600,000,000500,000,000400,000,000FFS Drugs Amt Paid300,000,000MC Drugs Amt Paid200,000,000100,000,0000FFS & MC Amt Paid(excluding drugs)
2011 HARP Spendby Primary Dx Class15HARPMENTAL DISORDERS ALL DSMIII CSIGNS, SYMPTOMS, AND ILL-DEFINED CONDITIONSINFECTIVE AND PARASITIC DISEASECIRCULATORY SYSTEM DISEASESDIGESTIVE SYSTEM DISEASESNATURE OF INJURY, ADVERSE EFFECTS AND POISONINGDISEASES OF THE RESPIRATORY SYSTEMAll Other/Not Avail
Top 15 Defined DiagnosisHARP and Non HARP16HARPPrimary Diagnosis29570 SCHIZOAFFECTIVE DISORDER, UNSPECIFIED29530 PARANOID TYPE SCHIZOPHRENIA, UNSPECIFIED042HUMAN IMMUNODEFICIENCY VIRUS HIV DISEA30391 OTHER AND UNSPECIFIED ALCOHOL DEPENDENCE30400 OPIOID TYPE DEPENDENCE, UNSPECIFIED30390 OTHER AND UNSPECIFIED ALCOHOL DEPENDENCE311DEPRESSIVE DISORDER, NOT ELSEWHERE CLASS29590 UNSPECIFIED SCHIZOPHRENIA, UNSPECIFIED2989UNSPECIFIED PSYCHOSIS29181 ALCOHOL WITHDRAWAL30401 OPIOID TYPE DEPENDENCE, CONTINUOUS29534 PARANOID TYPE SCHIZOPHRENIA, CHRONIC WIT29574 SCHIZOAFFECTIVE DISORDER, CHRONIC WITH A29680 BIPOLAR DISORDER, UNSPECIFIED29634 MAJOR DEPRESSIVE AFFECTIVE DISORDER, 0968,3879,7875,8726,4522,5452,2269,0637,837MC 523,1882,6836345495,2092,255non-HARPFFS and MCAmount Paid 159,328,334 105,044,651 104,316,782 81,159,216 69,298,004 62,106,215 58,204,609 55,211,888 51,700,492 41,482,049 40,322,503 34,719,342 33,160,450 32,545,953 29,780,455FFS ,1131,8144,11251736810,4694,412MC 9516403,1772581466,2932,893FFS and MCAmount Paid 41,280,139 19,648,775 90,040,040 8,391,289 124,330,964 51,305,194 65,863,232 22,356,517 47,039,972 8,039,806 11,914,195 5,289,405 4,417,911 66,066,971 13,514,406
cy 2011 top 20 health plans - harp/non-harp 11 plan name harp non-harp fidelis 19,904 54,279 health first phsp inc 14,409 33,138 metroplus health plan inc 11,262 27,756 affinity health plan inc 7,330 20,476 health plus phsp inc 6,605 18,754 blue choice/blue choice optio 6,777 18,338 united healthcare of ny inc 6,238 16,127
