The Medicaid Redesign Team (MRT) of New York State was launched by Governor Andrew Cuomo with the explicit mission of overhauling the nation’s largest Medicaid program. Upon taking office, Governor Cuomo determined New York’s Medicaid program was spending more than $50 billion annually and was growing at an unsustainable rate, putting the state’s entire budget in serious jeopardy, with unacceptable health outcomes for Medicaid members. Recognizing the program required real reform pursued in collaboration with key stakeholders, Governor Cuomo issued an executive order in January 2011 that called for the creation of the MRT to uncover ways to save money and improve quality within the Medicaid program for the 2011–12 state budget. MRT members included health care industry leaders, business and consumer leaders, state officers, and state legislative members. The MRT utilized an intensive stakeholder engagement process to develop a plan to reduce costs in New York’s Medicaid program while also focusing on improving quality and implementing reforms. MRT reforms saved taxpayers $2.2 billion dollars in the first year, and will save $34 billion in state and federal dollars in the first five years of implementation.
The MRT plan includes:
- Care Management for All: a multiyear phase-in to care management for all Medicaid members, resulting in healthier patients and lower costs.
- Patient Centered Medical Homes (PCMHs): increased financial incentives for providers to become nationally certified PCMHs. More than 1.6 million Medicaid members are now enrolled in PCMHs, where they have ongoing relationships with a personal physician and care team that takes collective responsibility for patient care. The goal is that within five years, all Medicaid members will be enrolled.
- Healthy Homes: a “high touch” care management model that serves high-need/high-cost Medicaid populations with expanded care coordination capabilities.
- Global Medicaid Spending Cap: established a two-year state-share dollar cap and a four-year state-share spending cap, monitoring Medicaid expenditures more closely than ever before. A global spending report is published to the MRT website monthly so the public can track performance.
MRT changed the political environment by bringing key stakeholders together to develop a multiyear reform plan. Most observers predicted failure. However, thanks to strong leadership and commitment, the process worked and the stakeholders were able to come up with a plan to transform the program. Over 230 separate initiatives have been or are still being implemented, and savings have been significant. Since the inception of MRT in 2011, per recipient spending has been reduced by approximately 10 percent, bringing spending in line with 2003 levels. Overall spending has been held virtually flat during a period of enrollment growth driven by a weak labor market and the Affordable Care Act. The reform process and the plan itself are being looked at by states across the nation and could be a model for national entitlement reform. MRT also created the opportunity for federal approval of a groundbreaking Medicaid waiver that is now being implemented to transform health care delivery, which will benefit all 19.5 million New Yorkers.