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NEW YORK OLMSTEAD CONFERENCE

October 5, 2010

ALBANY

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An OverviewMedicaid Long Term Care Expenditures: NEW YORK – FY 2009

• Personal Care $2.721Billion 14%• All HCBS Waivers $4.854 Billion 24%• Home Health $1.775 Billion 9%• Nursing Homes $7.618 Billion 38%• ICF-MR $3.112 Billion 15%

• Total $20.080 Billion

• In 2009, 53% of New York’s total Medicaid long term care expenditures went to institutional care (nursing homes and ICF-MR). Only 47% went to community based, non-institutional services (Home and Community Based Waiver, Personal Care and Home Health)

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New York Per Capita Expenditures FY 2009

• Highest expenditures per capita for nursing homes in the country --- $390. National average $163

• Highest expenditures per capita for ICF-MRs -- $159. National average $42

• Second highest expenditures per capita for PC -- $139. National average $38

• Fifth highest expenditures per capita for all HCBS Waivers -- $248. National average $109

• Highest expenditures per capita for HH -- $91. National average $14

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New York’s Nursing Home 6/31/2010

• Total NH Population• 105,881 [6/30/2010] of whom 14.5%

64 years old and under--- 15,353 younger PWDs

• 111,656 [6/30/2003] of whom 12.5% 64 years old and under---13,957 younger PWDs

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MA Residents in NY NH

63.1% of total NH residents were MA recipients. 66,811 residents on MA.

2008 MA per diem NH reimbursement$215.62 per day, or

$6,468.50 per month, or

$77,623 per year

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WHO WANTS OUT?

• As of 6/31/2010, • 20.6% of the 105,881 --- 21,811 people with

disabilities --- indicated they wanted to live in the community.

• 18.2% --- 19,270 – had a “support” person in the community who was positive about the person returning to the community.

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Change from 2004 to 2009 of NY’s Total LTC MA Expenditures

• FY 2004 A/D 63.7% to NH vs. 36.6% to community– National average 74.9% to NH vs. 25.1% to community

• FY 2008 A/D 61.0% to NH– National average 68.4% to NH

• FY 2009 A/D 61.7% to NH vs. 38.3% to community– National average 66.2% to NH vs. 33.8% to community

• FY 2004 ID/DD 44.2% to ICF vs. 55.8% to community– National average 42.4% to ICF vs. 57.6% to community

• FY 2008 ID/DD 40.6% to ICF– National average 35.5% to ICF

• FY 2009 ID/DD 39.2 % to ICF vs. 60.8% to community– National average 34.2% to ICF vs. 65.8% to community

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Change from 2004 to 2009 of NY’s Total LTC MA Expenditures IN $$$

$and National Average• RE people with A/D:

• FY 2004: $6.487 Billion of NY’s LTC MA expenditures went to institutions.

• FY 2008: $7.249 Billion of NY’s LTC MA expenditures went to institutions.

• FY 2009: $7.619Billion of NY’s LTC MA expenditures went to institutions.

Not Chopped Liver!!!!!!

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NY’s trends

• Comparing NY institutional expenditures with national average:

• For ID: • 2004, NY was 1.8% above nation. • 2009, OH was 5.4% above national average –

significant increase.

• For PD/A: 2004, NY was 8.3% above nation. 2009, NY was 4.3% below the national average!

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2004- 2009 A/D

• 2004 NY spent 36.3% of its LTC budget to HCBS - 9th best in nation.

• 2004 – NM best 55.2% , West Coast 47.8%, national average 22.7%

• 2008 increased its proportion of HCBS by only 2.7% (36th).

• DC best 27.6%, Louisiana 19.2%,Average was 5.5 increase%.

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2004- 2009 A/D REBALANCING as % of LTC!!??

• Between 2004 and 2008, NY increased its LTC budget by over $1.6 billion.

• Between 2004 and 2008, BUT 54.8% of this increase went to HCBS, ranking it 29th.

• BUT in 2009, % dropped to 47th.• Other States “rebalanced” at a rapid pace,

e.g., DC from 12.7% to 45.6%; WA 49.6 to 62%, Louisiana 10.6% 5o 32.5%