Drastic revisions to the New York Medicaid system have been well documented in recent years. Most attention relates to a crackdown on fraud and similar cost-cutting measures. The spur for the alternations, as with so many government program decisions, is the hope of reigning in costs and ensuring the program’s viability for many years to come.
There is an assumption that saving on costs can only be accomplished by taking away available services. But that is not always the case. Take, for example, the long-term care aspect of Medicaid. The annual cost of care in a skilled nursing facility is incredibly high. New York homes have some of the steepest price tags in the country. On top of that, many residents would rather not live in the restrictive facilities in the first place. Obviously some of the most ill seniors simply must have around-the-clock care. But others who may be able to live off less intensive support are forced to move into a facility for lack of options. In other words, it is a situation where the state is paying significantly for a service that many would rather not have anyway.
Fortunately, in recent months the state has worked to flip the model, saving money and providing more tailored service in the process. A Wall Street Journal story last week touched on some of the general themes of the change.
The main idea is to shift residents in need of less intensive care into “supportive housing apartments.” Unlike facilities that provide skilled nursing home care, the apartments would help with more general tasks, like budgeting, coordination on third-party medical care, and forms of counseling. All moves into these facilities would be voluntary.
New York is now unrolling a $47 million pilot project where 12 of these apartment complexes will be built to provide aid to about 5,000 New Yorkers. The state’s Medicaid director noted that the projections suggest that it will cost the program anywhere from $50 to $70 a day per resident. That is a huge drop from the average nursing home cost of $210 per day (Note that many private nursing homes charge significantly more).
One challenge to this transition is that the costs will be borne entirely by the state, without the usual 50% match from the federal government. Yet, the benefits seem so significant, that officials plan to go ahead anyway.
The NY Medicaid director explained the move, “While I hear you that there are concerns about patient safety and things like that, there are enough people currently in New York state that are too restrictive, that are greater than they need on a daily basis. There are a lot of low-hanging fruit of patients who do not need this restrictive care but have nowhere to go.”