Data released at the first meeting of the governor’s Medicaid Redesign Team on Tuesday provided an updated picture of the program’s long-term care costs, and the results were eye-opening.

The numbers showed a particularly striking trend for “personal assistance,” which refers to non-medical care, such as bathing and feeding, provided to people with disabilities, typically by aides with little or no training.

According to the data shared on Tuesday, state-funded spending on this type of care has more than doubled in just the past four years, to $5.7 billion – or about $11.4 billion with federal matching aid included.

personal-care-2-9989028
Sources: U.S. Centers for Medicare & Medicaid Services, NYS Department of Health (click to enlarge)

 

New York has long been an outlier with respect to this benefit, which is optional under federal Medicaid rules. Although it’s covered by 33 states, New York alone accounted for 40 percent of national Medicaid spending on personal assistance as of 2016.

Recent data on the other 32 states is not available, but that 40 percent ratio has no doubt increased significantly in the four years since.

Another benchmark of New York’s outlier status is per capita spending (total spending divided by total population). As of 2016, the per capita rate for personal assistance was $279, which was six-and-a-half times higher than the U.S. average and 65 percent more than the No. 2 state, which was Massachusetts.

Based on the new numbers released Tuesday, that already high figure has more than doubled – to $581 as of 2020.

per-cap-16-and-20-4114822
Sources: U.S. Centers for Medicare & Medicaid Services, NYS Department of Health (click to enlarge)

 

Traditionally, personal assistance was provided through home-care organizations, which would hire and train the aides and assign them to Medicaid recipients on behalf of the state. Most of the recent growth, however, has been in the Consumer-Directed Personal Assistance Program, or CDPAP, a variant in which recipients hire and train their own caregivers, who can be family members or friends.

According to numbers shared at Tuesday’s meeting, New York’s CDPAP spending has soared by more than 800 percent over five years, from $287 million in fiscal year 2016 to a projected $2.8 billion in 2021. Spending on agency-provided personal assistance also increased during that same period by 44 percent, from $2.5 billion to $3.6 billion.

These unusually fast growth rates were highlighted by state officials as among the major reasons that Medicaid spending has run billions of dollars over budget in recent years, opening a $4 billion deficit in fiscal year 2020 and a $3.1 billion projected gap for 2021.

Little wonder, then, that CDPAP and long-term care appeared at the top of a priority list for “course correction” at Tuesday’s meeting.

Governor Cuomo recently appointed the Medicaid Redesign Team to find $2.5 billion in cost savings to help balance the state budget due by April 1. The panel’s co-chairman, Northwell Health CEO Michael Dowling, said he hoped to publish recommendations by mid-March.

About the Author

Bill Hammond

As the Empire Center’s senior fellow for health policy, Bill Hammond tracks fast-moving developments in New York’s massive health care industry, with a focus on how decisions made in Albany and Washington affect the well-being of patients, providers, taxpayers and the state’s economy.

Read more by Bill Hammond

You may also like

Budget Update Paints Less Alarming Picture of Federal Health Cuts

A new fiscal report from the state Budget Division suggests federal funding cuts will hit New York's health-care budget less severely than officials have previously warned. A relea Read More

Parsing the Impact of Mamdani’s Tax Hike Plans

The front-running candidate for New York City mayor, Zohran Mamdani, has said he can finance his costly campaign promises – including free buses and universal child care – by taxing only a sliver of the city's residents Read More

K-12 SOS. Buffalo City School District

K-12 SOS is a pilot project of the Empire Center to inform parents, politicians, and decision-makers about the state of K-12 education in New York State. Determining why certain schools perform better than others is beyond the scope of this research. Read More

DOH Ducks a Simple Question on Covid in Nursing Homes

Five years after the coronavirus pandemic, the state Department of Health is pleading ignorance about one of its most hotly debated policy choices of the crisis – a directive that sent thousands of infected patients into Read More

An Eerie Silence About the State of Education in New York

A by National Assessment of Educational Progress (NAEP) lamented the declining state of U.S. education by highlighting how scores in grade 12 math and reading have hit record lows. While Covid-19 was definitely a factor, others correctly pointed out that Read More

In the Fight Over ACA Tax Credits, the Stakes Are Lowest for New York

As Washington skirmishes over the future of enhanced tax credits under the Affordable Care Act, New York has relatively little to gain or lose. The number of New Yorkers using any A Read More

New York’s Immigrant Health Coverage Becomes a National Flash Point

A little-noticed New York program that provides Medicaid coverage to elderly undocumented immigrants was thrust onto the national stage this week as the White House sparred with congressional Democrats over the federal gove Read More

Why New York’s Health Premiums Keep Going Up

New Yorkers continue to face some of the costliest health premiums in the U.S., and the insurance industry's recently finalized rate applications shed light on why that is. In summa Read More