New York Medicaid Recipients Sent to Hospitals More Frequently Than Privately Insured

When local residents conduct New York long-term care planning they usually want to ensure that they will have the resources to pay for the needed care and that it will be of the highest quality possible. It is one thing to have access to caregivers to provide day-to-day assistance when age takes its toll. It is another to have the peace of mind of knowing that the care will allow them to maximize their quality of life. When discussing these issues one advocate has echoed a common songwriter’s refrain, “there is a difference between living and living well.”

Proper preparation often makes all the difference and allows community members to ensure that their well-being will be prioritized in their golden years. Our New York elder law attorneys have worked for decades on these issues. For example, it is appropriate for some residents to obtain long-term care insurance (LTCI). LTCI serves two purposes: It protects assets from the costs of elder care and it provides resources for that care. For a variety of reasons, LTCI may be out of reach for some community members. In those cases it is usually beneficial to create a Medicaid Asset Protection Trust to shelter assets while still qualifying for Medicaid benefits.

Long-term care insurance often allows residents to maximize their quality of life, because it provides resources to pay for things like at-home care. At-home care has consistently been shown to be the preferable method of aging for those given a choice. However, even with LTCI, at some point a senior may need to move into a nursing home to have access to emergency services to survive each day. Yet, when at a nursing home those with private insurance may be treated differently than those on Medicaid according to new research from the University of Rochester Medical Center. The latest study, summarized this week in McKnight’s Long-Term Care News, revealed that those in nursing homes on Medicaid are sent to the hospital 27% more than those receiving private insurance.

At first researchers assumed that the difference was caused by the fact that Medicaid residents are more likely to live in nursing homes that have fewer resources. Therefore, those residents might require extra hospital care while privately insured residents would more often be treated on-site at their skilled nursing facility. However, now experts believe that the difference relates back to finances. Nursing homes are usually reimbursed less when they provide treatment to a New York Medicaid resident as opposed to one covered by private insurance. Therefore, they have a financial incentive to pass on the cost to hospitals of treating certain residents as opposed to others. The study’s authors explain that this new data is important, noting that the hospitalization differences actually have “significant impact on the long-term health of residents.”

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