Millions of elderly people in the New York have extensive health care needs and expenses, but many have limited incomes or savings to assist them cover the cost of care. Virtually all elderly New York residents have Medicare, the federal health insurance program for disabled and elderly Americans, to assist pay medical bills (Stokes, 2004). However, limits in the scope of benefits, coupled with financial obligations and problems for coverage, can lead to a serious financial burden (Zahra, 2004). Elderly persons with low incomes are particularly vulnerable to these problems because they are more likely to have health problems than higher-income Medicare beneficiaries, yet are not much able to afford care. In addition, they are less likely to be able to be much accessible or afford the supplemental coverage that many Medicare beneficiaries buy to assist fill in Medicare’s gaps.
Generally, elderly persons are less healthy and have higher health care needs than the general population. Nearly a third of people age over sixty-five reports that their health status is poor or fair, compared to 18% of people age 55 to 64 and just 6% of those ages 25 to 44 (Stokes, 2004). A significant percent of elderly persons live with severe or disabling health problems, such as arthritis (56 %), hypertension (53 %), and heart disease (36 %), and many live with multiple chronic conditions (69%). These are all conditions that need increased contact with the health care system and ongoing care, including regular visits with a health care provider, prescription and medications, at times, other inpatient medical services or hospitalization (Zahra, 2004).
Another problem that affects Medicaid spending for the elderly is the fact that New York Medicaid spent about $10 billion on inpatient care in 2003. That was almost three times the national average on a per-capita basis (Stokes, 2004). However, experts suggest that New York City relies heavily on hospitals is due to the large number of medical schools, teaching hospitals, and many research centers that located within the state. In addition, labor unions representing hospital workers influence the political process to keep funds rolling in. Nationally, Medicaid pays for two-thirds of all nursing home patients. In New York State, the figure is almost eight in every 10 (78 percent). Therefore, a small percentage of the Medicaid money spent on long-term care in the United States is spent in New York compare to the other states. New York also spends more than other states on programs whose aim is to allow people to eschew nursing homes.
However, New York Sate has come up with policies that control the Medicaid spending on the elderly. New York State Partnership for Long-Term Care is a different program combining long-term care insurance and Medicaid Extended Coverage (Zahra, 2004). It is to help New Yorkers financially prepare for the possibility of needing nursing home care, home care or assisted living services someday (Stokes, 2004). The program permits New York residence to secure some or all of their assets (resources), depending on the insurance plan bought, if their long-term care requires extend beyond the period covered by their private insurance policy.
If you purchase New York State Partnership for Long-Term Care insurance from participating insurers, use the importance according to the conditions of the program, and you are living New York State, you can easily apply for New York State Medicaid Extended Coverage which may assist in paying for your continuing care (Ronald, 1998). Unlike all the regular Medicaid, Medicaid Extended Coverage permits you to protect some or all of your assets, depending on whether you select either Dollar for Dollar Asset Protection plan or a Total Asset Protection plan. However, your income is countable in getting your eligibility for Medicaid Extended Coverage.
The Partnership was form to help New Yorkers finance long-term care without impoverishing themselves or signing over their life savings, with the accompanying loss of dignity. In the long run, the program will have help reduce New York’s Medicaid long-term care spending – more than $9 billion in 2003. The Partnership offers New York residents and New York State a better alternative
The Effective Health Care Program Stakeholder Group is a party which is part of the Citizen’s Forum initiative, funded by the America Recovery and Reinvestment Act, to formally and widely engage stakeholders, and to enhance and expand public involvement in the whole Effective Health Care enterprise. This Stakeholder Group brings input to the Effective Health Care Program to improve the applicability and relevance of research products to health care decision makers (Stokes, 2004).
With Medicaid responsibilities divided among multiple agencies, the role of forming and ensuring the implementation of program-wide priorities rests with the Governor’s staff and the Division of the Budget. This budget is majorly set with an intention of improving and maintaining the elderly care (Ronald, 1998). In this theory, the Governor’s staff is in a position to transcend private and individual agency or office agendas, examining the Medicaid program entirely, identifying the major policy goals, and ensuring that agency roles advance those goals. The effectiveness of the Governor’s staff in fulfilling this role is in part determined by the mandate and authority it is given by the Governor (Zahra, 2004). Furthermore, because the Governor’s staff is relatively small in relation to the wide portfolio it handles, staff members’ experience and expertise and the priority assigned to Medicaid issues are also critical factors. However, there have been claims from this stakeholder about the misappropriation of funds for the elderly in New York Sate.
Like the Governor’s staff, it does not have the same level of programmatic expertise as the agencies charged with directly administering Medicaid-funded programs that were established in order to maintain the care of the elderly people in New York (Zahra, 2004). It cannot single-handedly develop Medicaid policies nor operationalize them. Several DOB’s ability to address the financing of Medicaid in a comprehensive way was empowered four years ago when its unit responsible for mental hygiene programs was merged with the unit responsible for DOH.
In conclusion, future additional burdens on Medicaid coverage of elderly New York residents are especially problematic in light of the fact that the existing program still requires several improvements (Zahra, 2004). Nowadays, Medicaid’s coverage of the low-income Medicare population is very limited. In 1997, the program reached only half of all the poor New York residents, and 13% of near-poor, Medicare beneficiaries. States have the option to extend full Medicaid benefits to all Medicare beneficiaries at greater income levels or use more liberal ways for determining income and assets for eligibility, but allowable and levels assets generally remain low. Additionally, various Medicare beneficiaries who are eligible for Medicare premium assistance through the purchasing programs, particularly the QI and SLMB programs, are not enrolled (Zahra, 2004). Lack of specific outreach efforts, burdensome and complex enrollment processes, and limited benefits entirely contribute to limited enrollment. Automatic eligibility determination or simplified and a meaningful benefit would assist expand the scope of Medicaid coverage for low-income elderly persons in New York State
Zahra, F. (2004), Medicaid in New York: a causal analysis of utilization in New York counties, New York: State University of New York
Brooking Institute Staff, (1998), Functions and Activities of National Government in the Field of Welfare, New York: Scholarly Press.
Ronald, I. (2003), Money and capital in economic development, Washington: Brookings Institution Press.
Donald, T. (2007), Pasteur’s quadrant: basic science and technological innovation, New York: Brookings Institution Press.
Stokes, J. (2004), Washington D. C.: Functions and Activities of National Government in the Field of Welfare. New York: Scholarly Press