United Hospital Fund Publishes First-of-Its-Kind Report with Comprehensive Data on Medicaid Long-Term Care Programs in New York

The Report Will Inform Policymakers as the State Looks to Restructure Long-Term Care Services

Release Date: 05.14.2009
Contact: rdeluna@uhfnyc.org
Contact Phone: 212-494-0733

A new report from the Medicaid Institute™ at United Hospital Fund—titled An Overview of Medicaid Long-Term Care Programs in New York— is the first and only data compilation of its kind, aiming to inform current policy discussions about how to address challenges associated with New York's Medicaid long-term care programs. The report provides an overview of the current organization of long-term care services under New York's Medicaid program, a September 2007 snapshot of program enrollment and associated annual spending, and a summary of the rules that govern how each program operates.

The report also identifies policy options for addressing the key challenges facing the state as it looks at options to better serve New York's frail seniors and adults with physical disabilities through its 12 long-term care programs—two residential and 10 community-based. In addition to a chapter providing an overview of the entire system, four other chapters offer data about the largest programs—nursing homes, personal care, long-term home health care, and managed long-term care—through which most New York beneficiaries receive their care and most dollars are spent.

Among the findings in the comprehensive report:

• 65% of people enrolled in New York's Medicaid long-term care programs are served through community-based programs.

• Roughly 2/3 of the state's Medicaid long-term care beneficiaries have needs requiring nursing home levels of care.

• More than half of New York's long-term care beneficiaries have some degree of cognitive impairment.

• 53% ($6.6 billion) of total spending in New York State on long-term care goes to residential long-term care programs, while 47% ($5.8 billion) goes to community-based programs.

• The majority of spending in community-based programs is attributable to hands-on help with activities of daily living, such as eating, toileting and bathing.

As the only public insurance program that covers long-term care services, Medicaid plays a fundamental role in the lives of frail seniors and adults with physical disabilities. Each month, an estimated 247,000 Medicaid beneficiaries receive long-term care through one of 12 distinct programs. Because many of these beneficiaries have chronic illnesses and disabilities, care can be intensive and costly. In 2007, Medicaid spending for these programs was roughly $12.3 billion, about one-quarter of all Medicaid spending in the state.

“With heightened fiscal and demographic pressures, workforce shortages, and scarcity of affordable housing, we expect long-term care under Medicaid to come under growing scrutiny,” said Jim Tallon, president of United Hospital Fund. “But long-term care under Medicaid is the proverbial elephant in the room. Depending on where you are standing, you can see a trunk or a leg, but no one can see the whole elephant. This report, for the first time, presents long-term care in its true complexity.”

An Overview of Medicaid Long-Term Care Programs in New York is available free of charge, both in its component chapters and in its entirety.

The report was prepared by Alene Hokenstad, project director, and Meghan Shineman, policy analyst, both of United Hospital Fund, and Roger Auerbach, of Auerbach Consulting, Inc.

About the United Hospital Fund: The United Hospital Fund is a health services research and philanthropic organization whose mission is to shape positive change in health care for the people of New York.

About the Medicaid Institute™: The Medicaid Institute at United Hospital Fund provides information and analysis explaining New York's Medicaid program, with the goal of helping all stakeholders redesign, restructure, and rebuild the program.

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