New York Medicaid

1
New York Medicaid

• Tarren Bragdon
• Health Policy Analyst
• Empire Center for New York State Policy
• tbragdon_at_EmpireCenter.org

2
Medicaid Eligibility
6th highest
8th highest
8th highest
Source Kaiser Family Foundation,
StateHealthFacts.org
3
Medicaid Spending Per Enrollee
112 higher
110 higher
90 higher
90 higher
44 higher
Source Centers for Medicare and Medicaid
Services, 2003 figures
4
Medicaid Utilization Spending

• Definitions
• Clinic services These include preventive,
  diagnostic, therapeutic, rehabilitative, or
  palliative items or services that are provided to
  outpatients and by a facility that is not part of
  a hospital but is organized and operated to
  provide medical care to outpatients including
  services furnished outside the clinic by clinic
  personnel to individuals without a fixed home or
  mailing address.
• Home health - These are services provided at the
  patient's home, in compliance with a physician's
  written plan of care that is reviewed every 62
  days, including.
• Nursing services that is provided on a part-time
  or intermittent basis by a home health agency
• Home health aide services provided by a home
  health agency and
• Medical supplies, equipment, and appliances
  suitable for use in the home.
• The following optional therapy services are
  optional physical therapy, occupational therapy,
  or speech pathology and audiology services
  provided by a home health agency or by a licensed
  rehabilitation facility.

Source Centers for Medicare and Medicaid
Services, 2003 figures
5
Medicaid Utilization Spending

• Definitions
• ICF/MR (institutions for those with disabilities)
  - These are services provided in an institution
  for mentally retarded persons or persons with
  related conditions. The primary purpose of the
  institution is to provide health or
  rehabilitative services to such individuals.
• Personal care/support - These are services
  furnished to an individual who is not an
  inpatient or resident of a hospital, nursing
  facility, intermediate care facility for the
  mentally retarded, or institution for mental
  disease that are
• Authorized for the individual by a physician in
  accordance with a plan of treatment or (at the
  option of the State) otherwise authorized for the
  individual in accordance with a service plan
  approved by the State and
• Provided by an individual who is qualified to
  provide such services and who is not a member of
  the individuals family.
• Other services These include transportation,
  abortions, prosthetic devices, eyeglasses and
  home and community-based services for those with
  mental retardation and/or developmental
  disabilities (the majority of spending in NY
  likely falls in this last category with
  transportation being next)

Source Centers for Medicare and Medicaid
Services, 2003 figures
6
Medicaid Utilization Spending
Source Centers for Medicare and Medicaid
Services, 2003 figures
7
Medicaid Utilization Spending
Source Centers for Medicare and Medicaid
Services, FY2003 figures
Total savings does not include Managed Care
Drugs
8
Medicaid the Uninsured (those under 65 years
old)
Source US Census Bureau