1 NEW YORK OLMSTEAD CONFERENCE October 5, 2010 ALBANY

2 An Overview Medicaid Long Term Care Expenditures: NEW YORK – FY 2009 Personal Care$2.721Billion14% All HCBS Waivers$4.854 Billion 24% Home Health $1.775 Billion 9% Nursing Homes $7.618 Billion 38% ICF-MR $3.112 Billion 15% Total$ Billion In 2009, 53% of New York’s total Medicaid long term care expenditures went to institutional care (nursing homes and ICF-MR). Only 47% went to community based, non-institutional services (Home and Community Based Waiver, Personal Care and Home Health)

3 New York Per Capita Expenditures FY 2009 Highest expenditures per capita for nursing homes in the country --- $390. National average $163 Highest expenditures per capita for ICF-MRs -- $159. National average $42 Second highest expenditures per capita for PC -- $139. National average $38 Fifth highest expenditures per capita for all HCBS Waivers -- $248. National average $109 Highest expenditures per capita for HH -- $91. National average $14

4 New York’s Nursing Home 6/31/2010 Total NH Population 105,881 [6/30/2010] of whom 14.5% 64 years old and under--- 15,353 younger PWDs 111,656 [6/30/2003] of whom 12.5% 64 years old and under ---13,957 younger PWDs

5 MA Residents in NY NH 63.1% of total NH residents were MA recipients.66,811 residents on MA MA per diem NH reimbursement $ per day, or $6, per month, or $77,623 per year

6 WHO WANTS OUT? As of 6/31/2010, 20.6% of the 105, ,811 people with disabilities --- indicated they wanted to live in the community. 18.2% ,270 – had a “support” person in the community who was positive about the person returning to the community.

7 Change from 2004 to 2009 of NY’s Total LTC MA Expenditures FY 2004 A/D 63.7% to NH vs. 36.6% to community –National average 74.9% to NH vs. 25.1% to community FY 2008 A/D 61.0% to NH – National average 68.4% to NH FY 2009 A/D 61.7% to NH vs. 38.3% to community – National average 66.2% to NH vs. 33.8% to community FY 2004 ID/DD 44.2% to ICF vs. 55.8% to community –National average 42.4% to ICF vs. 57.6% to community FY 2008 ID/DD 40.6% to ICF –National average 35.5% to ICF FY 2009 ID/DD 39.2 % to ICF vs. 60.8% to community – National average 34.2% to ICF vs. 65.8% to community

8 Change from 2004 to 2009 of NY’s Total LTC MA Expenditures IN $$$$and National Average RE people with A/D: FY 2004: $6.487 Billion of NY’s LTC MA expenditures went to institutions. FY 2008: $7.249 Billion of NY’s LTC MA expenditures went to institutions. FY 2009: $7.619Billion of NY’s LTC MA expenditures went to institutions. Not Chopped Liver!!!!!!

9 NY’s trends Comparing NY institutional expenditures with national average: For ID: 2004, NY was 1.8% above nation. 2009, OH was 5.4% above national average – significant increase. For PD/A: 2004, NY was 8.3% above nation. 2009, NY was 4.3% below the national average!

A/D 2004 NY spent 36.3% of its LTC budget to HCBS - 9 th best in nation – NM best 55.2%, West Coast 47.8%, national average 22.7% 2008 increased its proportion of HCBS by only 2.7% (36 th ). DC best 27.6%, Louisiana 19.2%,Average was 5.5 increase%.

A/D REBALANCING as % of LTC!!?? Between 2004 and 2008, NY increased its LTC budget by over $1.6 billion. Between 2004 and 2008, BUT 54.8% of this increase went to HCBS, ranking it 29 th. BUT in 2009, % dropped to 47 th. Other States “rebalanced” at a rapid pace, e.g., DC from 12.7% to 45.6%; WA 49.6 to 62%, Louisiana 10.6% 5o 32.5%