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New York leads states in spending on long-term care, but not in quality

New York's Medicaid program spends more on long-term health care than any other state, but indicators of quality are "about average or slightly above average," according to a new report issued Friday by the Nelson A. Rockefeller Institute of Government.

The Institute's study examines a variety of factors that may influence such spending, including demographics, spending by type of care, characteristics of facilities, and varying policies among state Medicaid programs. New York was compared to 18 other large and Northeastern states including California, Texas, Florida, Massachusetts, New Jersey, Pennsylvania, and Ohio.

"The comparisons in this report show that the state has room to improve quality and lower costs," said Courtney Burke, director of the Rockefeller Institute's New York State Health Policy Research Center. "It's difficult to isolate any one particular cause of New York's relatively higher Medicaid spending on long-term care."

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New York spent almost $45 billion on combined federal, state, and local Medicaid benefit payments in 2006, the most recent year for which data were available. The next highest state in the study was California, which spent about $34 billion. New York also led all states in Medicaid spending on long-term care.

During 2006, the state spent some $19 billion on long-term care, while California was again second with about $12 billion. Adjusting such spending for the number of aging residents, New York spent an average of $5,500 on long-term care for each state resident over 65 - some 2.5 times the national average.

"Demographic differences in New York that may contribute to spending variations include a higher rate of persons over 85, a higher poverty rate among the elderly, and a greater acuity of patients in nursing facilities," said Ajita De, a research scientist at the Rockefeller Institute and author of the study. "Beyond demographics, other factors that may contribute to higher Medicaid long-term care spending in New York are the greater number of medically needy elderly, a greater percentage of persons in nursing homes that rely on Medicaid as their primary source of funding, the availability of a broader range of Medicaid long-term care services, and a higher number of special care nursing home beds."

Nursing homes in New York were cited for an average 5.1 deficiencies in 2006, compared to a national average of 7.5. On a measure of "serious" deficiencies - those that might result in "actual harm" or "immediate jeopardy" - 17.9 percent of New York nursing homes received citations, slightly below the national average of 18.1 percent of facilities. New York nursing homes scored better than those in most other states on measures including food sanitation and accident prevention, but poorly in ratings of avoiding pressure sores and preventing infections.

"New York also stands out because it has been generally more aggressive at implementing new policies and initiatives that expand Medicaid funded long-term care services such as Home and Community Based Waivers, Programs of All Inclusive Care for the Elderly, personal care, and home care," Burke said.