The Medicaid Institute™ at United Hospital Fund

An initiative of United Hospital Fund

Providing More Effective Long-Term Care

Medicaid plays an essential role in financing and delivering services for frail elderly and physically disabled New Yorkers who rely on long-term care services and supports, 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 $14.3 billion in 2011, or 27 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.

Related Publications

Medicaid Regional Data Compendium, 2014      

Published: 2014

This compendium gathers key data elements from various New York State Department of Health data releases and other related sources into short, easily digestible regional chartbooks providing a high-level overview of service utilization of New York’s Medicaid beneficiaries.

New York’s Medicaid in Transition      

Published: 2014

This comprehensive overview of New York’s Medicaid program provides essential grounding in the dramatically changing program, focusing on the changes related to the federal Affordable Care Act and the State’s Medicaid Redesign Team; it also presents recent data on spending and enrollment and examines complex reforms underway or planned for the near future.

Mandatory Managed Long-Term Care in New York's Medicaid Program: Key Eligibility and Enrollment Issues      

Published: 2014

This issue brief provides an overview of New York State’s mandatory Medicaid managed long-term care enrollment policy, which the State began implementing in 2012. It examines the growth in enrollment from 2010 to 2013, as well as growth by region and product line; and discusses key operational issues related to the major changes in eligibility and enrollment processes triggered by shifting high-need Medicaid beneficiaries from fee-for-service into managed care.

Home- and Community-Based Long-Term Care in New York's Medicaid Program: New Data on Service Use and Spending      

Published: 2014

This data brief documents the shift of Medicaid home- and community-based services from fee-for service into managed care between 2010 and 2013. It presents regional differences in services and spending, and evaluates the growth in Medicaid managed long-term care and the corresponding decline in fee-for-service home- and community-based services, particularly in personal care use, reflecting an explicit policy goal of New York.

New York's Nursing Homes: Shifting Roles and New Challenges      

Published: 2013

This report from the Medicaid Institute at United Hospital Fund examines nursing home trends in New York.

Integrating and Improving Care for Dual Medicare-Medicaid Enrollees: New York’s Proposed Fully Integrated Duals Advantage (FIDA) Program      

Published: 2012

This report from the Medicaid Institute at United Hospital Fund focuses on a proposed New York State program to better manage care of  beneficiaries who are enrolled in both Medicare and Medicaid, commonly referred to as “duals.”

Presentations from "Advancing Medicaid Reform"      

Published: 2012

These presentations were delivered at the conference "Advancing Medicaid Reform," held July 18, 2012.

Financing Long-Term Care: New York's Limited Options and Medicaid's Vast Challenge      

Published: 2012

An examination of how long-term care is financed nationally and in New York, with an analysis of the state’s private long-term care insurance market, opportunities presented by alternative financial products, and the pivotal role of default payer played by Medicaid.

Implementing Long-Term Care Reform in New York's Medicaid Program      

Published: 2012

One of two jointly released Medicaid Institute reports examining implementation of Medicaid policy changes in New York, this report explains and considers potential strategies and options for improving the management of long-term care services for elderly and disabled Medicaid beneficiaries, and addresses the issues of balancing residential and community-based long-term care, refining reimbursement for long-term care services, and providing effective care management.

Medicaid Personal Care in New York City: Service Use and Spending Patterns      

Published: 2010

Medicaid Personal Care in New York City: Service Use and Spending Patterns examines elderly dual Medicare-Medicaid beneficiaries in New York City, and a particular type of Medicaid long-term care service they receive—personal care, which includes assistance with eating, bathing, and dressing, as well as activities associated with independent living such as shopping and meal preparation. The report takes two distinct looks at one group of personal care recipients, elderly dual Medicare-Medicaid beneficiaries in New York City.

Medicaid Long-Term Care in New York: Variation by Region and County      

Published: 2010

Medicaid Long-Term Care in New York: Variation by Region and County analyzes rates of service use and levels of spending per recipient across New York State, documenting variation by region and by county. It also examines four interrelated factors—demographics, reimbursement policies, availability of service, and local administration—to begin to explain regional variation.

Presentation of "Managing Care for High-Cost Elderly Duals: A Challenge for Medicaid"      

Published: 2009

Delivered at the Fourth National Medicaid Congress in Washington, DC, this presentation reviews the findings and policy implications from the Medicaid Institute™ report of the same title.

An Overview of Medicaid Long-Term Care Programs in New York      

Published: 2009

This Medicaid Institute™ report 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.

Managing Care for High-Cost Elderly Duals      

Published: 2008

This analysis considers a cohort of about 259,000 elderly individuals enrolled in both Medicare and Medicaid, focusing on the high-cost 20 percent who account for some $3.5 billion in Medicaid spending annually.

Changes in Nursing Home Care, 1996-2005      

Published: 2008

This report documents a ten-year trend among New York's nursing homes, marking their growing role as providers of short-term care for people continuing recuperation after a hospital stay.

 

Medicaid Institute™ at United Hospital Fund
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