DEMOS

Links to Demos – PMPM and Medical Spend comparison / Enrollment Trends / Administrative Expense PMPM

Here is a table showing a Statewide Per Member Per Month (PMPM) Comparison. Medicaid Managed Care (MCO) Capitated Premium compared to Medical Spend (Less Kick Payments).

The delta between the average capitated payment received by MCOs from DOH Per Member Per Month (PMPM) and the average medical spend PMPM continues to shrink.

Average Managed Care Enrolled Medicaid Members by Region

MMCOR Regions
MMCOR Regions	2014	2015	2016	2017 Q2	4 Year Trend
Central	222,549	167,106	169,135	166,955	-25%
Finger lakes	253,656	169,525	172,324	171,669	-32%
Long Island	437,300	383,490	382,943	378,734	-13%
Mid-Hudson	155,653	150,916	153,383	151,442	-3%
Northeast	161,896	159,283	160,544	157,221	-3%
Northern Metro	307,759	221,314	223,426	218,982	-29%
NYC	1,541,418	2,586,985	2,556,173	2,552,362	66%
Utica-Adirondack	150,423	149,265	150,625	147,754	-2%
Western	387,140	360,472	363,763	358,825	-7%
Statewide	3,617,793	4,348,356	4,332,316	4,303,943	19%

(Click on a Region(s) to remove from the chart and/or left-click and drag your mouse to narrow the upper and lower limit)

Total Allowable Administrative Expenses Per Member Per Month (PMPM)

Medicaid Regions
Medicaid Regions	2014	2015	2016	2017 Q2	4 Year Trend
Central	28.83	31.65	33.46	34.49	19.7%
Finger lakes	29.57	31.29	33.59	31.58	6.8%
Long Island	36.07	38.86	39.21	39.51	9.5%
Mid-Hudson	25.62	30.33	30.24	29.68	15.9%
Northeast	30.22	29.71	34.50	34.23	13.3%
Northern Metro	25.47	29.60	29.87	30.42	19.4%
NYC	34.64	36.66	36.12	35.67	3.0%
Utica-Adirondack	26.97	28.94	29.05	28.81	6.8%
Western	34.46	34.85	37.27	34.39	-0.2%
Statewide	33.19	35.20	35.45	34.93	5.2%

(Click on a Region(s) to remove from the chart and/or left-click and drag your mouse to narrow the upper and lower limit)