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

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