New York a big spender on Medicaid long-term care

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It’s been a nickname since the 1920s, but here’s a new reason why New York is called the Big Apple: It spends BIG on long-term care.

Compared to other states, New York spends more than $5,500, or 2.5 times the national average, on long-term care for every elderly New Yorker (aged 65 or over). That is according to a February 2009 report from the Rockefeller Institute’s Health Policy Research Center. A tall order indeed.

In 2006, among 19 comparison states in the study, New York spent the most on Medicaid long-term care. Total long-term care spending in the state, including nursing homes, home care, and personal care, rose to $19 billion in 2006 from $13.7 billion in 2005.

So why does “the city that never sleeps” spend so much of its state Medicaid dollars on long-term care? There are a few main reasons why:

Demographics: New York has a higher than average percentage (more than 2%) of people 85 and older compared to the other 18 states. (Still, it is nearer the national average in regard to the number of people over 65.)

Poverty: A greater percentage (18%) of the elderly in New York are poor. The other states averaged 12%, according to the study.

Medically needy elderly: New York had more medically needy elderly (237,000) than the other 18 states in 2003. Medically needy individuals are those who don’t meet the income threshold for Medicaid but because of incurred medical expenses, become eligible.

Certified nursing facility (CNF) residents: While New York had fewer CNF facilities in 2006 compared to California, it had the highest total number of residents (110,139). New York’s occupancy rate was highest and it led in the total number of special care beds. Also, New York was second only to Louisiana with the number of CNF residents using Medicaid as the primary source of payment.

Range of long-term care services: New York has implemented new policies and initiatives that expand Medicaid-funded long-term care services. These include home- and community-based services waivers and Programs of All-Inclusive Care for the Elderly (PACE).

Unfortunately, spending does not necessarily correspond to quality. While it spends more than other states on Medicaid long-term care, New York is about average or slightly above on measures of quality, the report notes. It has room to both improve quality and lower costs, the study says.

This report is a worthwhile read. In identifying the factors that force up long-term care Medicaid costs, it sheds light on the grim realities that affect that spending. It’s easy to get caught up in the perception that states have frittered away their budgets. But, as the report indicates, New York is grappling with an elderly population of people who need medical care and can’t afford it. That problem is not so easy to fix.
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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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