Long-Term Care

 
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Because there is no effective private insurance market and no national government program for long-term care, responsibility for financing these services and supports falls principally to Medicaid.  
 

The United Hospital Fund's work on long-term care includes the analysis of financing and service delivery issues in the private and public sectors at the national, state, and local levels. The Fund monitors spending on long-term care, assesses new approaches and models of care, and informs discussions about the impact of federal and state policy on long-term care delivery and spending.

Because there is no national government program to provide long-term care services and supports to frail elderly and physically disabled individuals—and because there is no broad and effective private insurance market for long-term care—responsibility for financing long-term care in New York falls principally to Medicaid.  

Medicaid plays an essential role in financing and delivering services for New Yorkers who rely on long-term care, and that role is likely to grow in the coming years as the baby boomer generation ages.  Those dependent on long-term care are among Medicaid’s most vulnerable and complex beneficiaries, and because their care is related to conditions that are generally ongoing and often deteriorate over time, beneficiaries’ needs often persist and increase over periods of several years.  Over 300,000 New Yorkers receive Medicaid long-term care services each year, at an average cost of about $40,000 per recipient, totaling $13.4 billion in 2010, or 26 percent of total Medicaid spending in New York.  

Long-term care is a robust and particularly important component of New York’s Medicaid program, in great part due to the broad scope of community-based services the State covers.  About two-thirds of New York’s long-term care beneficiaries receive a range of home- and community-based services related to both health care needs and assistance with activities of daily living, while about a third receive care in nursing homes.  While New York has long been a leader among states in providing Medicaid beneficiaries access to needed care in their homes, there have been concerns about whether the delivery of long-term care services under Medicaid has been administered and managed effectively

As part of New York State’s broad and ongoing Medicaid reforms, a large subset of long-term care recipients—those who are over 21 years of age, dually eligible for Medicare and Medicaid, and require more than 120 days of community-based long-term care—are required to enroll in a managed long-term care plan.

Contact: David Gould