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Ease the Medicaid Burden

The Issue:

Upstate New York’s local tax burden is almost 71 percent above the national average. This is due in large part to the state’s unique Medicaid financing scheme in which counties equally share the state’s Medicaid obligations. New York’s Medicaid expenses per enrollee were over double the national average in 2005. 14 percent of total nationwide Medicaid dollars were spent in New York that year, even though New York had just nine percent of the nation’s total Medicaid population.

Other issues with the Medicaid program include its coverage of personal care spending and its failure to successfully prosecute fraud. On average, 19 percent of Medicaid dollars spent on personal care are spent in New York, making per capita personal care spending 187 percent above the national average. With regard to fraud prosecution, only 37 cases of Medicaid fraud across the entire state were investigated in 2004. Easing the Medicaid burden will require legislators to address these issues, as the program ties into tax reduction, budget reform, and spending restraint.

In Albany:

MACNY will support reforms that:

· Reduce “medically needy” loopholes by scrutinizing asset transfers and enforcing eligibility rules for the elderly and disabled.

· Expedite the implementation of disease state management programs.

· Implement more aggressive fraud prevention and detection programs.

· Encourage managed care participation.

· Limit the hours spent on personal care for the elderly and disabled living at home.