In my prior post, I provided and discussed New York State’s overall Medicaid spending in 2005, and spending by category of service. In this post, I’ll briefly discuss spending by age of beneficiary — a spreadsheet is attached for your further review. As noted, New York State accounted for 6.5% of the people in the United States, 7.3% of the poor people (2006 data), 9.3% of poor Americans over age 65 — and 8.4% of Medicaid beneficiaries. But there is a group for which New York’s share of U.S. Medicaid beneficiaries is much closer to its share of the overall population — those 18 and under. And, for that same group, spending per beneficiary is generally 25% to 50% higher than then national average, a fact related to the higher cost of living here. For those in some other age groups, spending per recipient is 70% or more higher than the national average, and/or New York State accounts for 10% or more of U.S. Medicaid recipients. I don’t think anyone is prepared to concede that New York State is cheating its children out of required Medicaid-financed services. So perhaps the number of child beneficiaries, and spending on them, is what one has to expect given the state’s higher poverty rate, higher cost of living Downstate, and one would hope greater generosity. New York should expect to account for 8% to 11% of the nation’s Medicaid spending, despite accounting for just 7.6% of its personal income. For other groups, another explanation is required for higher spending.
One group is those age 45 to 65 in 2005, or those who were born between 1940 and 1960 and reached age 22 from 1962 to 1982. New York’s spending per recipient is not particularly high for this group at 21% higher than the national average (compared with 67%) above average overall. But New York State accounts for 14.3% of U.S. Medicaid recipients in this age group, a sky-high share. As a result, the state accounts for 17.4% of U.S. Medicaid spending on this age group. And the $10.5 billion spend on it here is, stunningly, significantly more than the $7.4 billion spent on those age 65 to 84 in 2005?
I’d love to hear someone with the knowledge to do so explain this. My first thought is that this is the AIDS generation and AIDS is concentrated here relative to the U.S. Yet today AIDS is treated with cocktails of drugs, and New York State only accounted for 9.9% of the beneficiaries of drubs financed by Medicaid. Do New York’s most ill Medicaid recipients die before reaching age 65? Is this the age group for which those from other states with health problems come to New York, have a cup of coffee to establish residence, and then have surgery in one of our hospitals? New York State also accounts for 10.9% of the nation’s beneficiaries of Medicaid services age 21 to 44. Increasingly, younger New Yorkers are being hired as “independent contractors” or “freelancers” without employer provided health insurance — a national trend that is more common here. If they become ill or pregnant, they end up having their non-existent savings drained until they qualify for Medicaid. As my boss put it, we have national health insurance, the problem is that it is Medicaid and it sucks.
Readers of my prior post who are aware of New York’s high spending on Nursing Home care, Home Health Care, and home Personal care will not be surprised that New York State’s Medicaid spending per beneficiary is most of out line with the national average for senior citizens. It is 71% higher than the nation average for those age 65 to 74, 87% higher than average for those age 75 to 84, and 80% higher than average for those age 85 and greater. No one wants to see senior citizens suffer, although the question of where family and personal responsibilities end and social responsibilities begin (and in which state) needs to be asked. But I can’t recall hearing it said that seniors with actual needs are particularly well looked after here, or poorly looked after elsewhere. I have heard the “Medicaid Planning” is particularly common here, and there have been scandals related to unnecessary services — and non-existent beneficiaries — that have surfaced from time to time. And it is certainly the case, given the complaints about property taxes from senior citizens (who do not pay state and, in NYC local, income taxes on retirement income in New York) that the seniors themselves aren’t happy to pay for the higher costs.