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Seven Percent Of NY Medicaid Long Term Care Applications Denied

Armen Hareyan's picture
NY Medicaid Coverage Denial

Over the last decade, 7% of Medicaid health insurance long-term care applications in New York state were denied on the grounds that individuals transferred assets to become eligible for the program, but there is wide variation in counties' denial rates, according to a report published by the Rockefeller Institute of the State University of New York, the Rochester Democrat and Chronicle reports. About 42% of the $18.9 billion spent by the state on Medicaid in 2006 was for long-term care. New York spent $21,223 per Medicaid beneficiary older than age 65 in 2005, almost double the national average.

Individuals qualify for the program if their annual income is no higher than $8,700 and their total assets, excluding a home, are no higher than $13,050. Federal law prohibits the transfer of assets in the five years prior to applying for Medicaid benefits for nursing homes. However, such shifting of assets by middle-income individuals to qualify for Medicaid "is a common tactic among people who fear an extended nursing-home stay will eat up all of their savings," the Democrat and Chronicle reports.

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The report shows that the rate of Medicaid denials citing asset transfers made up 49% of the total received in Franklin County, 24% in Rockland County, 22.6% in Ulster County, 6.3% in Monroe County, 2.1% in Erie County and 0.5% in Westchester County. According to the authors, additional research is needed to explain these disparities between counties.

According to the report, the actual number of people who do not qualify for long-term coverage under Medicaid might be higher because "some people may have transferred assets in ways not detected by the state." The report states that the state Department of Health operates the Medicaid program, but the state Office of Temporary and Disability Assistance decides who qualifies for the program. This division means that "it can be difficult for (the health department) to extract and analyze these data quickly," according to the report. A spokesperson from the health department said the agency is reviewing the report but has not drawn any conclusions from it (Gallagher, Rochester Democrat and Chronicle, 4/10).

Used with permission from www.kaisernetwork.org