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  • 1. New York Medicaid Tarren Bragdon Health Policy Analyst Empire Center for New York State Policy [email_address]
  • 2. Medicaid Eligibility 6 th highest 8 th highest 8 th highest Source: Kaiser Family Foundation, StateHealthFacts.org
  • 3. Medicaid Spending – Per Enrollee 90% higher 112% higher 90% higher Source: Centers for Medicare and Medicaid Services, 2003 figures 44% higher 110% higher
  • 4. Medicaid Utilization & Spending
    • Definitions
    • Clinic services – These include preventive, diagnostic, therapeutic, rehabilitative, or palliative items or services that are provided to outpatients and by a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients including services furnished outside the clinic by clinic personnel to individuals without a fixed home or mailing address.
    • Home health - These are services provided at the patient's home, in compliance with a physician's written plan of care that is reviewed every 62 days, including.
      • Nursing services that is provided on a part-time or intermittent basis by a home health agency
      • Home health aide services provided by a home health agency; and
      • Medical supplies, equipment, and appliances suitable for use in the home.
      • The following optional therapy services are optional: physical therapy, occupational therapy, or speech pathology and audiology services provided by a home health agency or by a licensed rehabilitation facility.
    Source: Centers for Medicare and Medicaid Services, 2003 figures
  • 5. Medicaid Utilization & Spending
    • Definitions
    • ICF/MR (institutions for those with disabilities) - These are services provided in an institution for mentally retarded persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
    • Personal care/support - These are services furnished to an individual who is not an inpatient or resident of a hospital, nursing facility, intermediate care facility for the mentally retarded, or institution for mental disease that are:
      • Authorized for the individual by a physician in accordance with a plan of treatment or (at the option of the State) otherwise authorized for the individual in accordance with a service plan approved by the State; and
      • Provided by an individual who is qualified to provide such services and who is not a member of the individual’s family.
    • Other services – These include transportation, abortions, prosthetic devices, eyeglasses and home and community-based services for those with mental retardation and/or developmental disabilities (the majority of spending in NY likely falls in this last category with transportation being next)
    Source: Centers for Medicare and Medicaid Services, 2003 figures
  • 6. Medicaid Utilization & Spending Source: Centers for Medicare and Medicaid Services, 2003 figures
  • 7. Medicaid Utilization & Spending Source: Centers for Medicare and Medicaid Services, FY2003 figures Total savings does not include Managed Care & Drugs
  • 8. Medicaid & the Uninsured (those under 65 years old) Source: US Census Bureau