1. Ten Essential Reforms We Can’t Live Without
ISSUE Trim Medicaid’s Excess
THE NATION’S MOST EXPENSIVE
MEDICAID PLAN IS DAMAGING
OUR STATE’S HEALTH.
New Yorkers pay the highest bills in the nation for New York can no longer afford the nation’s richest
Medicaid, the government insurance program designed Medicaid program, but we don’t need a hatchet to
to provide medical care and long-term care services fix it. By trimming excessive benefits to more closely
for low-income and disabled people. With spending match national norms, the state can save billions
of nearly $52 billion this year, projected to grow of dollars.
another $1.8 billion next year, our Medicaid costs
are more than twice the national average per capita. SWOLLEN MEDICAID PLAN
Taxpayers should support the governor-elect’s proposals steps to
New York
SURVIVAL
to restructure the program and make it more efficient,
while encouraging steps that can be taken more quickly
to trim excessive costs. One step is to manage Medicaid
at the state level. Benefits today are administered by Administer Medicaid at the state
level; minimally, set reimbursement
$47.6b
the 62 county governments, with varying levels of
rates at the state rather than
efficiency and little incentive to trim costs. county level
California
Another is to change New York’s “spousal refusal” Eliminate New York’s unique
provision, which allows any married adult to qualify
for Medicaid long-term care services if the spouse
spousal refusal option for long-term
care eligibility $38.7b
(or parent of a sick child) refuses to pay. Spousal refusal Pass legislation that increases tax-
credit incentives for people to buy
is a major contributor to New York’s extremely high
costs for long-term care. State spending for Medicaid
private long-term care insurance Florida
Reduce the authorized number
$14.7b
long-term care was $1,058 per resident in 2008,
of personal care services hours
compared to a national average of $378.10
to 17 per week
New York also provides coverage for many services Change other optional benefits
to bring them more in line with
that aren’t required by the federal government, which New York spends more on Medicaid
other states
matches state Medicaid payments. One example benefits than any other state—$9,610
is personal care services for Medicaid recipients per enrollee compared to a U.S. average
of $5,830. (Kaiser Family Foundation)
who need assistance with daily living tasks, such as
housekeeping and shopping. By reducing the average
number of hours from 30 to 17 for this optional
service—still 50 percent above the national average
for personal care—taxpayers could save about
$1.5 billion annually.11