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Integrating services: Program evolution in New York

Statewide customer engagement enables transformation

Situation

  • The huge administrative costs of healthcare can create significant gaps in state budgets.
  • The cost of New York’s Medicaid program, the nation’s largest, had swollen to 32% of the state budget in 2010, posing a significant risk of bankruptcy for the state.
  • Having worked with Maximus since 1997, New York turned to us to support their ambitious vision for a revamped healthcare system.

Challenge

Close budget, staffing, and technology gaps by helping the state make sustainable reforms to Medicaid and other healthcare programs.

Solution

By taking over responsibility for — and consolidating — most citizen-facing services, we’ve enabled New York to focus its resources on improving efficiency and care.

In fact, with Maximus leading the way, New York was one of the first states to successfully implement a “single point of entry” model for consumers seeking public health insurance.

The centralized eligibility center we established for Medicaid now handles all eligibility and enrollment for 100+ programs statewide, shifting this burden from local counties. We helped New York leverage this infrastructure in 2013 to create New York State of Health, its state-based marketplace under the Affordable Care Act. In addition, our integrated call centers now support the state’s entire spectrum of health plans.

How we did it

New York’s success is the result of eight years of continuous, iterative improvements, including:

  • Creating and administering seamless, integrated customer support, which means “no wrong door” for a wide range of beneficiaries
  • Using innovative technology infrastructure across programs
  • Adapting to major changes such as the ACA, handling a surge in beneficiaries while mitigating cost pressures
  • Augmenting the state workforce, alleviating administrative burdens while freeing employees to focus on more complex or impactful work

Working with a trusted long-term partner like Maximus enabled the state to close various gaps and rebuild its healthcare system.

Results

$8 billion
to reinvest in reforms

10% reduction
in Medicaid costs per beneficiary

1/3 less cost
to operate call centers

150,000 calls
handled weekly

5 of 5
average client satisfaction ranking

Long-Term Care Assessments

When New York implemented managed long-term care for dual eligibles, we incorporated this into our scope, recognizing the unique needs of this population.

Our Conflict-Free Evaluation and Enrollment Center conducts independent assessments of applicants seeking long-term care services across the entire state, including 6,000 in-home assessments each month.