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Understanding New York's Medicaid Long-Term Care Expenditures

An overview of Medicaid expenditures for long-term care services in New York for FY 2009. Detailed analysis of expenditures on personal care, home health, nursing homes, and community-based waivers. Comparison with national averages and trends in long-term care spending.

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Understanding New York's Medicaid Long-Term Care Expenditures

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  1. NEW YORK OLMSTEAD CONFERENCE October 5, 2010 ALBANY

  2. An Overview Medicaid Long Term Care Expenditures: NEW YORK – FY 2009 • Personal Care $2.721Billion 14% • All HCBS Waivers $4.854 Billion 24% • Home Health $1.775 Billion 9% • Nursing Homes $7.618 Billion 38% • ICF-MR $3.112 Billion 15% • Total $20.080 Billion • In 2009, 53% of New York’s total Medicaid long term care expenditures went to institutional care (nursing homes and ICF-MR). Only 47% went to community based, non-institutional services (Home and Community Based Waiver, Personal Care and Home Health)

  3. New York Per Capita Expenditures FY 2009 • Highest expenditures per capita for nursing homes in the country --- $390. National average $163 • Highest expenditures per capita for ICF-MRs -- $159. National average $42 • Second highest expenditures per capita for PC -- $139. National average $38 • Fifth highest expenditures per capita for all HCBS Waivers -- $248. National average $109 • Highest expenditures per capita for HH -- $91. National average $14

  4. New York’s Nursing Home 6/31/2010 • Total NH Population • 105,881 [6/30/2010] of whom 14.5% 64 years old and under--- 15,353 younger PWDs • 111,656 [6/30/2003] of whom 12.5% 64 years old and under---13,957 younger PWDs

  5. MA Residents in NY NH 63.1% of total NH residents were MA recipients. 66,811 residents on MA. 2008 MA per diem NH reimbursement $215.62 per day, or $6,468.50 per month, or $77,623 per year

  6. WHO WANTS OUT? • As of 6/31/2010, • 20.6% of the 105,881 --- 21,811 people with disabilities --- indicated they wanted to live in the community. • 18.2% --- 19,270 – had a “support” person in the community who was positive about the person returning to the community.

  7. Change from 2004 to 2009 of NY’s Total LTC MA Expenditures • FY 2004 A/D 63.7% to NH vs. 36.6% to community • National average 74.9% to NH vs. 25.1% to community • FY 2008 A/D 61.0% to NH • National average 68.4% to NH • FY 2009 A/D 61.7% to NH vs. 38.3% to community • National average 66.2% to NH vs. 33.8% to community • FY 2004 ID/DD 44.2% to ICF vs. 55.8% to community • National average 42.4% to ICF vs. 57.6% to community • FY 2008 ID/DD 40.6% to ICF • National average 35.5% to ICF • FY 2009 ID/DD 39.2 % to ICF vs. 60.8% to community • National average 34.2% to ICF vs. 65.8% to community

  8. Change from 2004 to 2009 of NY’s Total LTC MA Expenditures IN $$$$and National Average • RE people with A/D: • FY 2004: $6.487 Billion of NY’s LTC MA expenditures went to institutions. • FY 2008: $7.249 Billion of NY’s LTC MA expenditures went to institutions. • FY 2009: $7.619Billion of NY’s LTC MA expenditures went to institutions. Not Chopped Liver!!!!!!

  9. NY’s trends • Comparing NY institutional expenditures with national average: • For ID: • 2004, NY was 1.8% above nation. • 2009, OH was 5.4% above national average – significant increase. • For PD/A: 2004, NY was 8.3% above nation. 2009, NY was 4.3% below the national average!

  10. 2004- 2009 A/D • 2004 NY spent 36.3% of its LTC budget to HCBS - 9th best in nation. • 2004 – NM best 55.2% , West Coast 47.8%, national average 22.7% • 2008 increased its proportion of HCBS by only 2.7% (36th). • DC best 27.6%, Louisiana 19.2%,Average was 5.5 increase%.

  11. 2004- 2009 A/D REBALANCING as % of LTC!!?? • Between 2004 and 2008, NY increased its LTC budget by over $1.6 billion. • Between 2004 and 2008, BUT 54.8% of this increase went to HCBS, ranking it 29th. • BUT in 2009, % dropped to 47th. • Other States “rebalanced” at a rapid pace, e.g., DC from 12.7% to 45.6%; WA 49.6 to 62%, Louisiana 10.6% 5o 32.5%

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