New York Medicaid Program Recovers Record $851 Million in 2013

Earlier this week new figures were released by the Medicaid Inspector General’s office which highlight the expanding crackdown on misuse of New York Medicaid funds.

As discussed in a NY Daily News story, last year state investigators recouped $851 million in allegedly misspent Medicaid funds. This marks nearly double the previous record, from 2012, of $468 million in savings. However, the sizeable figure for 2013 is due in large part to the recovery of nearly $496 million as part of a settlement with federal officials regarding billing for home health services.

These tallies represent a commitment by a growing number of state officials and lawmakers to ensure billing practices with Medicaid are above board and every taxpayer dollar is spent as efficiently as possible. Even with this “record setting” year, some officials, particularly fiscal conservatives, argue that more needs to be done to root out fraud and lower overall Medicaid spending.

How This Impacts New York Long-Term Care
So how does any of this impact New York seniors and their families who are considering their long-term care options?

It is impossible to predict with certainty, but the continuing crackdown on use of Medicaid funds will likely continue to influence application and benefit decisions for long-term care for those using the Medicaid program. Medicaid remains the largest single payer of long-term care services for seniors, including payments for nursing homes stays as well as at-home care. As the push for efficiency grows, that will be reflected in senior caregiving services.

Importantly, a drive for cost-savings does not automatically mean that long-term care benefits will be cut or seniors will suffer from substandard care as a result. Instead, both cost-savings and more ideal care may be provided by shifting to less expensive but superior arrangements–like at-home support.

However, considering the past issues of large at-home providers overbilling Medicaid, one can expect increased scrutiny on these companies. This may result in tightening restrictions on who qualifies for home aid or exactly what services are provided. At the same time, home health caregivers for seniors is one of the most in-demand professions, and many providers struggle to find quality caregivers. It is unclear how these changes Medicaid trends will impact these entities ability to provide needed services.

With the expansion of the NY Medicaid program via the Affordable Care Act as well as the internal push from Governor Cuomo to increase efficiency, change is in the air for the program. For that reason it is more critical than ever for families navigating these waters to speak with an experienced NY Medicaid lawyer who can help with applications, asset protection, and long-term planning.

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