NYC has been sending public health mixed signals!
A recent Post article notes an unexpected trend: a reduction in the number of uninsured people in NYC over the last several years. According to the article, of the 2.7 million New Yorkers enrolled in a public health insurance program (Medicaid, Child Health Plus, Medicare...) approximately one million of them first received benefits since 2002. Moreover, 90% of the city's children are insured, even if one includes the children of undocumented immigrants. So, according to the article, NYC is about halfway there: 1 million down, 1.3 million to go.
On the other hand, a Brooklyn judge recently ruled that the state has discriminated against thousands of mentally ill residents by placing them in "adult homes" instead of "supported housing". The New York Times reports the suit was brought by Disability Advocates, a nonprofit legal services group, under the auspices of the Americans with Disabilites Act. The judge ruled that these adult homes were "segregated settings"that did not provide residents with appropriate opportunities to cultivate daily living skills and personal independence. Interestingly, the cost per resident associated with an adult home is about $7,000 greater per year than the cost per resident in a supportive housing facility. ($47,936 vs. $40,253).
I work in such a supportive housing facility, and I think it strikes an excellent balance for its residents. Medical care is provided by a GP and a psychiatrist, both of whom come in weekly, and medication administration and monitoring is performed by myself, an RN, who is in twice a week. Moreover, each resident has a social worker to help them with a huge number of issues: government benefits and the associated paperwork, bills and financial management, part time work, and coordinating medical care when it goes beyond the on-site staff. Meanwhile, the residents maintain a high level of independence and self-sufficiency. Overall, it's great.
Showing posts with label Medicaid. Show all posts
Showing posts with label Medicaid. Show all posts
Monday, September 14, 2009
Tuesday, April 14, 2009
wide county by county variation in medicaid denials
Last Thursday the Rockefeller Institute of Government published a report on the county by county variation in denials of applications for Medicaid funding of long term care. Individuals in New York are eligible for Medicaid funding for nursing home care if they make less than $8,700 per year, and if their total assets are less than $13,500, not including their home. Federal law prohibits the transfer of assets by the elderly for five years prior to applying for Medicaid nursing home benefits; obviously the intention of the law is to prevent people would could afford a nursing home on their own from filing for benefits after giving their money family member, friend, etc. so they could access it later. The report, which analyzed the state's 57 counties outside New York City, studied the rate at which Medicaid benefits are denied because of a reported asset transfer.
In the last decade, 7% of the applications for Medicaid benefits for long term care have been denied on the basis of a recent asset transfer. However, the rate at which applications are denied varies wildly from county to county. Some of the counties that deny with the most frequency are: Rockland (24.2%), Ulster (22.6%), Saratoga (14.6%), and Suffolk (14.5%). Some that deny the least are: Westchester (0.5%), Duchess (1.0%), Schenectady (1.2%), Rensselaer (1.3%), Orange (1.4%), and Erie (2.1%). The report offered no opinion as to why the variation exists, but the authors did note their suspicion that the illegal asset transfers are underdetected.
New York has one of the most generous Medicaid programs in the country; in 2006, 42% of the $18.9 billion the State spent on Medicaid went to funding long term care.
In the last decade, 7% of the applications for Medicaid benefits for long term care have been denied on the basis of a recent asset transfer. However, the rate at which applications are denied varies wildly from county to county. Some of the counties that deny with the most frequency are: Rockland (24.2%), Ulster (22.6%), Saratoga (14.6%), and Suffolk (14.5%). Some that deny the least are: Westchester (0.5%), Duchess (1.0%), Schenectady (1.2%), Rensselaer (1.3%), Orange (1.4%), and Erie (2.1%). The report offered no opinion as to why the variation exists, but the authors did note their suspicion that the illegal asset transfers are underdetected.
New York has one of the most generous Medicaid programs in the country; in 2006, 42% of the $18.9 billion the State spent on Medicaid went to funding long term care.
Friday, February 27, 2009
shocker
A NYT article from Tuesday examines why some many people enrolled in Medicaid in New York State fail to re-enroll at the appropriate time. The major reason: the re-enrollment process is inefficient, untimely, and, according to one participant in focus groups, "takes a lawyer to figure out". The necessary documents fail to reach their intended recipients, or do so after they are due back to the state.
This is totally unsurprising. I work part time at a facility for formerly homeless people, packaging meds and giving shots. There are about 45 residents here who need aggressive case management by their social workers, and one of the social workers' most significant time commitments is working on these programs' red tape. One social worker told me it can take up to one third of her time (although she said lately it had been much better) and another told me it was about a sixth. They both work 35 hours per week; if we average those two, we get eight hours and forty five minutes spent per week on Medicare/Medicaid. On the one hand, yes, they are managing about a dozen people. But the head of a household whose healthcare comes via Medicare/Medicaid could easily have to act as a caseworker for three or four people, without the benefit of a Master's degree, colleagues to help them sort things out, or a paycheck for their time. No wonder people are failing to re-enroll.
This is totally unsurprising. I work part time at a facility for formerly homeless people, packaging meds and giving shots. There are about 45 residents here who need aggressive case management by their social workers, and one of the social workers' most significant time commitments is working on these programs' red tape. One social worker told me it can take up to one third of her time (although she said lately it had been much better) and another told me it was about a sixth. They both work 35 hours per week; if we average those two, we get eight hours and forty five minutes spent per week on Medicare/Medicaid. On the one hand, yes, they are managing about a dozen people. But the head of a household whose healthcare comes via Medicare/Medicaid could easily have to act as a caseworker for three or four people, without the benefit of a Master's degree, colleagues to help them sort things out, or a paycheck for their time. No wonder people are failing to re-enroll.
Wednesday, February 4, 2009
budget cuts create controversy
Two powerful health care groups are mounting an aggressive public relations campaign against Governor Paterson's proposed reductions in health care spending, the New York Times reported Sunday. The two groups, Union 1199 and the Greater New York Hospital Association, are purchasing radio and TV spots, funding a phone bank, and mailing flyers throughout the state to protest the governor's $3.5 billion in health care spending cuts, part of a larger $15 billion package designed to balance the budget. The NYT estimates the radio and TV ads alone will cost more than $1 million per week.
Yesterday Paterson and Senate Democrats balanced this year's fiscal budget, which ends March 31, with many small cuts that collectively covered the $1.6 billion deficit. This cost health care in New York "$359 million...including cuts for nursing homes and health maintenance organizations, grants and higher assessments for health insurers" according to Reuters. Also among the cuts: $75 million for the Environmental Protection Fund, and $306 million from the Power Authority.
For FY2010, there is a projected $13-15 billion dollar deficit. In December 2008, the Governor proposed an additional $3.5 billion in health care spending reductions. The centerpiece of the cuts, profiled on the Governor's website , would cap Medicaid spending in New York at $16 billion, which would nevertheless be an increase over spending in 2008-2009. However, it is over $1 billion less than the projected need of $17.2 billion during FY2010, and would reduce the amount of federal aid spent in New York state. More later on other proposed cuts.
Union 1199, more formally 1199 S.E.I.U. United Healthcare Workers East, is the health care portion of Service Employees International Union, covers New York, NJ, Maryland, DC, and Massachusetts. Its members are typically technicians who work in the health care field: certified nursing assistants, xray technicians, home attendants, etc. There are also members who are registered nurses, but these are relatively few. The union boasts 300,000 members and claims to be the largest local union in the world. The GNYHA covers more than 300 hospitals in the greater NY area.
Yesterday Paterson and Senate Democrats balanced this year's fiscal budget, which ends March 31, with many small cuts that collectively covered the $1.6 billion deficit. This cost health care in New York "$359 million...including cuts for nursing homes and health maintenance organizations, grants and higher assessments for health insurers" according to Reuters. Also among the cuts: $75 million for the Environmental Protection Fund, and $306 million from the Power Authority.
For FY2010, there is a projected $13-15 billion dollar deficit. In December 2008, the Governor proposed an additional $3.5 billion in health care spending reductions. The centerpiece of the cuts, profiled on the Governor's website , would cap Medicaid spending in New York at $16 billion, which would nevertheless be an increase over spending in 2008-2009. However, it is over $1 billion less than the projected need of $17.2 billion during FY2010, and would reduce the amount of federal aid spent in New York state. More later on other proposed cuts.
Union 1199, more formally 1199 S.E.I.U. United Healthcare Workers East, is the health care portion of Service Employees International Union, covers New York, NJ, Maryland, DC, and Massachusetts. Its members are typically technicians who work in the health care field: certified nursing assistants, xray technicians, home attendants, etc. There are also members who are registered nurses, but these are relatively few. The union boasts 300,000 members and claims to be the largest local union in the world. The GNYHA covers more than 300 hospitals in the greater NY area.
Wednesday, January 28, 2009
Kaiser studies Medicaid/SCHIP eligibility
The Kaiser Foundation has released its eighth annual 50 state survey on Medicaid/SCHIP eligibility. Nationwide, the principal findings of the study were optimistic. It reports that “the commitment to children remains strong” and that many states have broadened Medicaid access in the past year despite economic challenges. The authors noted, however, that it is still more difficult for parents to get Medicaid than children.
The study broadly affirmed that New York has some of the most liberal Medicaid requirements in the country. New York’s Medicaid/SCHIP income eligibility requirements were consistently at or above the national median. Some things that set New York apart:
- New York both working and jobless parents could qualify for Medicaid even if their income was more than 100% of the federal poverty level (FPL). Nationally, the median cutoff is 68% of FPL for a working parent and 41% of FPL for a jobless parent. (In some states, even working parents must make less than 50% of FPL to qualify for Medicaid, which leads one to wonder how some state legislators interpret the word “poverty”.)
- New York provides Medicaid to pregnant women at 200% of FPL; the national median is 185%.
- New York provides children with SCHIP (In NY, Child Health Plus) up to 400% FPL. When New York passed legislation raising eligibility from 250% to 400%, the Center for Medicaid and Medicare Services (CMS) rejected the plan, and children who fall between 250% and 400% are now paid for with state funds.
- New York is one of 23 states in which a an adult working at the state minimum wage qualifies for Medicaid.
The study also discussed ways in which New York’s generous policies are expanding:
- New York has adopted the option to allow children leaving foster care upon reaching age 18 to keep their Medicaid coverage.
- In February 2008, New York introduced a “presumptive eligibility law” for SCHIP.
The study broadly affirmed that New York has some of the most liberal Medicaid requirements in the country. New York’s Medicaid/SCHIP income eligibility requirements were consistently at or above the national median. Some things that set New York apart:
- New York both working and jobless parents could qualify for Medicaid even if their income was more than 100% of the federal poverty level (FPL). Nationally, the median cutoff is 68% of FPL for a working parent and 41% of FPL for a jobless parent. (In some states, even working parents must make less than 50% of FPL to qualify for Medicaid, which leads one to wonder how some state legislators interpret the word “poverty”.)
- New York provides Medicaid to pregnant women at 200% of FPL; the national median is 185%.
- New York provides children with SCHIP (In NY, Child Health Plus) up to 400% FPL. When New York passed legislation raising eligibility from 250% to 400%, the Center for Medicaid and Medicare Services (CMS) rejected the plan, and children who fall between 250% and 400% are now paid for with state funds.
- New York is one of 23 states in which a an adult working at the state minimum wage qualifies for Medicaid.
The study also discussed ways in which New York’s generous policies are expanding:
- New York has adopted the option to allow children leaving foster care upon reaching age 18 to keep their Medicaid coverage.
- In February 2008, New York introduced a “presumptive eligibility law” for SCHIP.
Sunday, January 18, 2009
safety net as stimulus?
The Kaiser Foundation put out this analysis over a week ago, but it’s still worth posting. It addresses an aspect of the health care safety net that I haven’t heard discussed much in the context of the recent recession: how the spending of these programs can actually bolster the economy. The analysis is a review of 29 studies of 23 states, as well as one national study conducted by Families USA.
The study’s main finding is “Medicaid spending generates economic activity, including jobs, income and state tax revenues, at the state level.” The study finds it does so in two ways: the trickle-down (or “multiplier”) effect, and the Federal Medical Assistant Percentage (FMAP). According to the study, the trickle-down effect varies according to the size of the health care sector in a given state, the extent to which the state relies on Medicaid, and the FMAP for that state, but it is always there. The FMAP is a federal match program in which the federal government provides at least one dollar of federal money for every one dollar of state money spent on Medicaid. It’s determined using a formula that compares the state’s average income to the national average income. The FMAP for Mississippi, the poorest state, is 76%; that is, 76% of the dollars spend on Medicaid in that state come from the federal government. New York’s FMAP is the minimum, 50%.
The authors make the point that the FMAP means Medicaid pulls at least as much money into the state as the state is spending, and, at times, significantly more. For example, if Mississippi were to cut $1 of Medicaid out of its budget, it would lose $4.17 of healthcare spending in that state. Since that $4.17 will no longer be circulating in the state, the state’s economy has lost more by limiting spending than it gained by saving. For every dollar New York cut, it would lose two in spending. This is an important point as legislators look for ways to trim budgets.
Although none of the state-specific studies analyzed are devoted to New York, the national study, conducted by healthcare watchdog group Families USA, does have New York-specific information. Published in April ‘08, the study uses the Regional Input-Output System (RIMS II) to quantify the trickle-down effect of Medicaid cuts proposed by President Bush last year. The study estimated that $1.5 billion in lost federal funding would result in $1.1 billion in lost wages, $3.1 billion in lost business activity, and 25,500 lost jobs for the state.
The study’s main finding is “Medicaid spending generates economic activity, including jobs, income and state tax revenues, at the state level.” The study finds it does so in two ways: the trickle-down (or “multiplier”) effect, and the Federal Medical Assistant Percentage (FMAP). According to the study, the trickle-down effect varies according to the size of the health care sector in a given state, the extent to which the state relies on Medicaid, and the FMAP for that state, but it is always there. The FMAP is a federal match program in which the federal government provides at least one dollar of federal money for every one dollar of state money spent on Medicaid. It’s determined using a formula that compares the state’s average income to the national average income. The FMAP for Mississippi, the poorest state, is 76%; that is, 76% of the dollars spend on Medicaid in that state come from the federal government. New York’s FMAP is the minimum, 50%.
The authors make the point that the FMAP means Medicaid pulls at least as much money into the state as the state is spending, and, at times, significantly more. For example, if Mississippi were to cut $1 of Medicaid out of its budget, it would lose $4.17 of healthcare spending in that state. Since that $4.17 will no longer be circulating in the state, the state’s economy has lost more by limiting spending than it gained by saving. For every dollar New York cut, it would lose two in spending. This is an important point as legislators look for ways to trim budgets.
Although none of the state-specific studies analyzed are devoted to New York, the national study, conducted by healthcare watchdog group Families USA, does have New York-specific information. Published in April ‘08, the study uses the Regional Input-Output System (RIMS II) to quantify the trickle-down effect of Medicaid cuts proposed by President Bush last year. The study estimated that $1.5 billion in lost federal funding would result in $1.1 billion in lost wages, $3.1 billion in lost business activity, and 25,500 lost jobs for the state.
Subscribe to:
Posts (Atom)