Medicaid 2016-2019 Audited Wrap Rates and 2023 Wrap Rates Released

The Division of Budget has released two rate packages, which you can expect to see in your July 17, 2024 Medicaid check (cycle 2445):

1. 2016-2019 MCVR Audited Wrap Rates: Results from these audits have been posted on the HCS portal. You can review the details there.
2. 2023 Wrap Rates (Effective 10/1/23-9/30/24): Based on the 2022 MCVRs. Any claims already paid since 10/1/23 will be reprocessed at the new rate.

Please review your rate sheets carefully for accuracy. Check the visit counts and managed care average rates, and ensure that any recent rate appeals have been incorporated. Click here for the calculator tool presented by Dolores DiRe from CohnReznick at the May Reimbursement Committee meeting. This tool has been redesigned to match DOH’s rate sheets and will help you assess the financial impact of the new rates and verify their accuracy.

CHCANYS actively engaged with the state multiple times to support health centers with liabilities. We advocated for waiving the 10.5% interest on any liabilities and requested they hold the audited wrap rates until the release of the 2023 wrap rates, both of which they agreed to.

Recoupment Process for Health Centers with Liabilities:

• Recoupments will be automatically deducted at a rate of 15% from each Medicaid payment weekly until the total owed amount is fully repaid.
• The 15% recoupment rate may be increased if necessary to ensure full repayment within one year.

Due to CHCANYS advocacy, DOH has agreed to waive the prime plus 2% interest rate for this liability. You will still see this interest in the eMedNY system as part of your liability; however, it will be manually removed upon full payment of the principal.

For health centers needing extended repayment terms, please contact the Medicaid Account Receivable Recovery Unit at bimamail@health.ny.gov to discuss individual agreements. In the past, health centers have been able to secure a repayment plan of up to 36 months.

If you have a retroactive increase, the payment will be generated and applied in full. Please see Medicaid’s email to health centers for more details.