To wrap up 2022, I shared a blog post on the State of the Long-Term Care Industry that seems to have resonated with many, so I’m continuing as we begin 2023 with a related topic – a behind-the-scenes look at Medicaid in New York State.

What does Medicaid provide? Who qualifies? Why is Medicaid important? These fundamental questions are so important to answer to understand the value of this program, the individuals it serves, and why it requires our immediate attention.

What does Medicaid provide?

In short, Medicaid provides health insurance coverage to individuals who qualify (more about who qualifies below). In New York State’s words, it “pays for a wide range of services, depending on your age, financial circumstances, family situation, or living arrangements. These services are provided through a large network of health care providers that you can access directly using your Medicaid card or through your managed care plan if you are enrolled in managed care.”

Who does Medicaid serve?

The most recent numbers provided by the New York Department of Health say that it provides health coverage to 5.4 million New Yorkers through Medicaid. Individuals who are currently receiving Medicaid coverage include:

• Working poor
• Children
• Individuals with intellectual developmental disabilities
• Adults with behavioral health needs
• Elderly people

Who funds Medicaid?

Medicaid is funded by the federal government and each state’s government. The breakdown for New York State is 50/50. Unfortunately, New York State has only increased the Medicaid rate for long-term care by 1% one time in the last 14 years. In that timeframe, in pre-inflationary dollars, costs grew by 42%. New York State now has the lowest nursing home Medicaid rate in the country relative to revenue and expenses. Only seven percent of facilities have costs completely covered by Medicaid – and 42% have less than 80% of costs covered.­ On average, New York State’s nursing home Medicaid rate covers only 76% of Medicaid costs. By the way, this information is all from 2019, prior to the Coronavirus Pandemic and the staffing mandate (see my previous post with details on the mandate here).

In the long-term care industry, in New York State, for example, 75% of the residents in nursing homes are supported by the Medicaid program. For Loretto, which serves 10,000 individuals each year, 72% of residents are supported by Medicaid, and we have a shortfall of over $100 per person per day, or a $7 million shortfall each year, in providing care for these residents.

What can I do to support Medicaid?

You can be an advocate for New York seniors by contacting your legislator and ask them to support the senior safety net by providing reimbursement that covers costs. Please go to this link and complete the simple form and submit. It should only take a few seconds to complete and your voices matter most.