As of July 2005, there are 26 fully licensed managed care health plans, 17 prepaid health services plans (PHSPs) and 15 managed long term care (MLTC) plans in New York. PHSPs primarily serve the Medicaid, Child Health Plus and Family Health Plus populations, and MLTC plans provide or arrange for and coordinate both the health care and long term care needs of the frail elderly and chronically disabled.
HPA member plans — 17 fully licensed plans, 8 PHSPs and 3 MLTC plans — provide health care coverage to nearly 6 million of the state´s 7 million New Yorkers enrolled in managed care plans. Additionally, the New York State Health Insurance Program (NYSHIP), the state´s own preferred provider organization (PPO), provides health benefits to more than 1 million government employees and their families. Overall, managed care health plan enrollment in New York accounts for 44% of the state´s total population, and more than 53% of the insured population.1
New York´s health plans provide coverage to virtually every segment of the population. In fact, higher risk groups account for 51% of the total health plan enrollment in New York, including:
1.1 million New Yorkers enrolled in point-of-service (POS) products, which allow people to see providers outside the plan´s network and generally appeal to consumers with greater health care needs;
2 million Medicaid recipients enrolled in health plans through the New York State Medicaid Managed Care program;
497,000 previously uninsured New Yorkers covered through plans´ participation in the state´s Family Health Plus program;
324,000 previously uninsured New York children covered through plans´ participation in the state´s Child Health Plus program;
525,500 Medicare members; and
93,000 previously uninsured New Yorkers covered under the state’s Healthy New York program.
The US Census Bureau estimates approximately 2.7 million of New York´s nearly 19 million residents are currently without any health insurance coverage.
1Enrollment figures and percentages based on NYS Dept. of Health Office of Managed Care June 2004 report and US Census Bureau population and uninsured estimates. Figures do not include enrollment in PPOs other than NYSHIP, as this information is not reported to the Dep. of Health.
