Assessing New York's health care disparities using health plan quality data

To assess whether New York's extensive use of waiver programs and financial incentives for quality provided to Medicaid managed care plans resulted in reduced health care disparities by using the newly developed Health Insurance Disparities Index (HeIDI) to compare the performance of commercial/private vs Medicaid plans in New York (and separately for New York's Medicaid Health and Recovery Plan [HARP] plans for individuals with severe mental illness or substance use disorder) vs the nation as a whole.

The HeIDI methodology utilizes public quality metrics reporting from the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set to produce an annual score for disparities comparing the performance of commercial/private health maintenance organizations (HMOs) nationally vs Medicaid HMOs nationally, and similarly for New York.

Using NCQA's and New York's e-Quality Assurance Reporting Requirements (eQARR) data sets for measurement years 2019-2023, performance was analyzed employing the HeIDI methodology. HeIDI scores were compared between national Medicaid plans and New York's Medicaid mainstream plans and HARP plans.

Between 2019 and 2023, New York's Medicaid plans consistently outperformed national Medicaid plans by a factor of 2. New York's HARP plans similarly outperformed the national mainstream Medicaid plans during the same time frame. This suggests that New York's approach to managing Medicaid produces more equitable care between enrollees with different income levels compared with plans nationally.

Compared with other states, New York has made substantial progress in its Medicaid managed care programs. Future research questions include identifying specific New York initiatives or health plan characteristics that drive this superior performance.