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Verdict Still Out on Success of New York Medicaid Shift?

Late last month the New York Health Department released a report that reviews the progress of a crucial shift in state policy affecting seniors needing long-term care. The full report (download it here), outlines the satisfaction of New Yorkers who have participated in the shift from traditional New York Medicaid coverage for long-term care to special HMOs to cover those care and costs. This report offers the first good opportunity to analyze whether these organizational shifts over the past few months have been positive for those seniors directly affected.

Somewhat quietly, thousands of elderly New Yorkers who previously received long-term care via Medicaid were shifted to HMOs managed by by private and non-profit companies. In total, 38 different companies are handling the work and, according to the NY Health Department, “providing high-quality services to consumers and helping them maintain or improve critical abilities associated with daily living.”

The law changed in 2010 to alter the way long-term care was provided by the state. The basic idea is that shifting long-term care costs to HMOs will save funds. In 2010, for example, the state spent more than $13 billion via Medicaid to provide long-term care to 300,000 residents. By shifting to HMOs, the costs will hopefully be kept in check, because the companies will receive a flat fee for patient care overall, regardless of the necessary services.

The latest report on the change notes that sizeable majorities of participants reported in surveys that they saw marked improvement in their abilities, were satisfied with their plans, and would recommend them to others. However, outsides observers are skeptical and point out that the latest report needs to be taken with a grain of salt, because some seniors may not benefit from the Medicaid changes.

Latest Concerns
A recent WNYC article on the subject notes that the report fails to mention how senior lives were actually affected by the situation. For example, there is no indication of how many seniors have been moved from independent living situations to nursing homes following the change. Similarly, little data is provided on the prevalence of certain injuries which are indicative of quality of care–such as the development of bed sores.

Summarizing the critiques of the report, one elder care advocate explained, “There’s nothing about how much services are being given: home care services, adult daycare services, physical therapy, occupational therapy, meals on wheels. We know something about demographics, but we don’t know anything about where the money is going.”

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