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Greg Chambery

New York Long Term Care Medicaid - A Steady Transformation

It has been a wild roller coaster ride in New York State government since Andrew Cuomo took the reigns.  Governor Cuomo was saddled with a very tough financial situation and has made some good headway in beginning to get our State back on it's feet again.  One thing that everyone agrees upon is that there is still a long way to go.  As we search for solutions, one basic concept seems pretty clear.  State government is either going to need to do more with less or completely discontinue programs and services that have been offered in the past.  The last few months has revealed what some of these changes are to be in the area of Medicaid reimbursement for Long Term Care. Providers are beginning to see what the future will look like.

Medicaid is the system that reimburses facilities for care of patients who essentially have no resources to pay for themselves.  It is called the "Payer of last resort".  What it has become in the last 20 years is essentially a middle class insurance policy.  We see 80% of the care in New York State nursing homes being funded by the Medicaid program.  Some New Yorkers have failed to provide for themselves in terms of thinking about who will pay for their long term care if and when they need it.  Mr. Cuomo knows that with the increasing numbers of "Baby Boomers"  the approach of leaving things the way they are  is unsustainable.  Something needs to be done and it needs to be done fairly quickly.  In terms of the government moving quickly, my experiances have typically taken that to mean about 3 years.  The speed at which this is happening is telling me it is truely a crisis.  Let me tell my readers what has happened in the last 3 months.

Here is a summary of what the 2012 budget wants to do in health care:

The Executive Budget supports implementing health homes for complex high-cost recipients, investments in primary care and affordable housing, and the continued move to care management for all Medicaid recipients, which is expected to be completed in 2015-16. A cost neutral package of new initiatives is also proposed through the MRT to make critical investments in health care delivery, including funding for increased payments to essential community providers, tobacco cessation efforts and maternal child health initiatives. These investments are balanced by savings resulting from improvements in benefits design, more appropriate treatment outcomes and compliance with Federal law that requires that legally-responsible relatives, living in the same household as a Medicaid applicant, have their income and resources counted in determining Medicaid eligibility. [emphasis added]

In plain english, Long term care providers are seeing the following:

1.  Proposal to eliminate the concept of Spousal refusal where under certian circumstances a spouse was able to disavow financial responsibility for an institutionalized partner.

2.  A new concept of Health Homes which has yet to be revealed in detail.  The idea is to take some patients who may otherwise live in nursing homes and place them into health homes.

3.  A new pricing system where facilities are paid the same rate for patients similar to the Medicare system.  Right now, if the same patient were to be cared for at Maplewood, St. Anns and Monroe Community Hospital, the state would pay 3 different prices for care in those facilities.  Under a pricing system, the rate for the care would be the same from one facility to the next.

4.  Slimming down of the state government administration of services and the movement toward more efficient contracted services.  In the big picture it includes managed care.

There will definitely be more information that will follow and we will stay on top of it here at Maplewood.  It should be an interesting couple of years ahead.