Aging population drives New York’s Long-Term Medicaid Care spending

ALBANY, N.Y. (NEXSTAR) — Lots of Medicaid spending in New York goes to long-term care, frequently because of disabilities, chronic illnesses, or age-related health problems. New analysis from the nonpartisan think tank the Fiscal Policy Institute figures that the high spending comes from high enrollment among seniors, not necessarily because of wasteful, excessive costs per enrollee.

You can check out the brief from the Fiscal Policy Institute at the bottom of this story. It says that, as New York's elderly population grows in the coming years, the balance between accessibility and sustainability represents an ongoing statewide economic concern.

Medicaid covers essential services like hospital stays, prescription drugs, mental health treatment, and preventive care. Medicaid long-term care helps people perform daily activities like bathing, getting dressed, eating, and managing medication over an extended period. That includes payments to staff at nursing homes, assisted living, in-home care, and rehabilitation centers.

The Fiscal Policy Institute points out that the New York State Legislature purposefully focused on making long-term care—especially home care—more accessible to the middle and working classes in recent years, which pushed up overall numbers. Over 19% of New York's seniors qualify for Medicaid long-term care, almost double the national average of 10.5%. Only Washington, D.C. and California have higher rates.

Michael Kinnucan, Senior Health Policy Advisor at the Fiscal Policy Institute, who wrote the brief, said that such spending is common where states connect residents to effective services. Per enrollee, New York ranks lucky No. 13 for spending on seniors who have both Medicare and Medicaid, and eighth for spending on disabled individuals, behind states like Connecticut and Washington.

Giving more context, Ann Marie Cook—President and CEO of Lifespan of Greater Rochester—said that New York has a higher percentage of older adults than in other states. New York has more older adults on Medicaid, she said, because we are the fourth most populous state for older adults, behind California, Texas, and Florida.

Even so, in 2021, elderly and disabled people made up 20.7% of New York’s Medicaid enrollees while accounting for 59% of spending. Nationally, they represent just 21.1% of enrollees at 52.3%.

And long-term care specifically sucks up most of it—43% of New York's Medicaid spending in 2020, for example. Of that long-term care spending, home care services account for 71.2%. Cook said that persisting COVID-era workforce shortages force vulnerable people to seek out care at higher prices.

"Thousands of working- and middle-class families have gotten significant relief from the crushing costs of long-term care," said Democratic State Sen. Liz Krueger, who chairs New York's Senate Finance Committee. "But heading into the next few years, we know there's a real risk that Trump will pull the rug out from under those families, plunging thousands of older and disabled New Yorkers into desperate situations. In that case, it will be up to the Legislature and the Governor to do what we can to protect New Yorkers from Trump's attacks."

Meanwhile, Republican State Sen. Jake Ashby, ranking member of the Senate Committee on Agin, agreed that the governor must do more to fix Medicaid, which he called broken. "We're a national outlier in who can receive Medicaid and what it covers," reads part of a statement from Ashby. "What do we have to show for it? Shortchanged providers, overburdened taxpayers, and middling patient outcomes. It doesn't add up."

Funded through federal, state, and county contributions, Medicaid long-term care provides services that patients can't afford. But you don't need to be considered poverty-stricken to need help from Medicaid. Since Medicare doesn’t cover most long-term care services for the elderly or disabled, Medicaid covers the gap.

Nursing home care in New York costs nearly $160,000 per year. Today, private home care is more common and considered more cost-effective, but it can pass $100,000. Statewide, incomes average about $105,100 for a four-person household in 20024, according to the U.S. Department of Housing and Urban Development.

New York spends more per person on Medicaid long-term care than most other states, too—$10,884 per enrollee in 2021, above the national average of $9,175. Spending per child or adult was below national averages, but senior and disabled costs were much higher—$32,830 per senior in New York against $24,247 nationally.

Plus, New York’s overall per capita long-term care spending dwarfs the national average. In 2021, the state spent $1,520.59 per resident on long-term care, behind only Washington, D.C. Check out the Medicaid benefit spending per eligible enrollee for that year:

	National	New York
All Enrollees	$9,175	$10,884
Child	$3,591	$3,326
New Adult Group	$7,508	$6,969
Other Adult	$6,388	$5,972
Disabled	$26,762	$35,689
Aged	$24,247	$32,830

Take a look at the Fiscal Policy Institute analysis: