MEDICAID IN ERIE COUNTY
Medicaid in Erie County is a vital program assisting low-income individuals with various services. The county shares costs and covers mandatory as well as optional services under the program. Detailed statistical data analysis provides insights into the program's impact and expenditure patterns in Erie County.
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MEDICAID IN ERIE COUNTY An Analysis of Statistical Data for the Period January 1, 2011 through June 30, 2015
Medicaid Joint Federal State health insurance program that assists persons with low income and limited resources. County governments administer Medicaid and pay a portion of Medicaid costs Presently, due to these various funding adjustments and also due to the State s Medicaid Cap process, the Erie County share of total Medicaid expense ranges from 13% to 15%. The County s annual expense for Medicaid-MMIS is still the single-largest appropriation account in Erie County s operating budget.
Medicaid Mandatory Services Mandatory Services: States Must Cover Inpatient and outpatient hospital services Physician, midwife and certified nurse practitioner services Laboratory and x-ray services Nursing home and home health care for individuals over the age of 21 Early and periodic screening, diagnosis, and treatment (EPSDT) for children under 21 Family planning services and supplies Rural health care/federally qualified health center services
Medicaid Optional Services Optional Services: States May Cover Diagnostic, screening, preventive, rehabilitative services Clinical services Intermediate care facilities for the mentally retarded (ICFs/MR) Prescribed drugs and prosthetic devices Optometrist services and eyeglasses Nursing facility services for children under age 21 Transportation services (may be covered, must be assured) Physical and occupational therapy Home and community-based care to certain persons with chronic impairments Dental services (for adults) New York State covers nearly all the optional services for Medicaid.
New York State Medicaid Data Warehouse Contains the individual transaction records for all Medicaid transactions in New York State Database is covered by the legal and regulatory provisions of the Health Insurance Portability and Accountability Act ( HIPAA ). However, amalgamations of data are allowed. MIG Team has access to the data for Erie County. Other County personnel have access to selected portions. This access allows the MIG Team to better focus audit work.
Erie Countys Medicaid Inspector General Audits Has completed or is in the process of completing 23 audits reviewing more than $80 million in Medicaid transactions Works on a variety of projects and cooperate with NYS OMIG and law enforcement agencies. Three employees and is funded through the State under a 2012 agreement.
Federal Medical Assistance Percentage The (FMAP) is the federal share of Medicaid costs. Federal Medical Assistance Percentage FMAP is calculated annually using a formula set forth in federal statute. The FMAP for New York State for the federal government s last fiscal year is 50%. New York State shares the lowest FMAP percentage in the nation with fifteen (15) other states. The highest FMAP percentage in 2015 is 73%.
Revised FMAP under the ACA The Patient Protection and Affordable Care Act (ACA) creates a new national Medicaid minimum eligibility level: the Medicaid Expansion. Income eligibility: In 2015, a family of four generally qualified with an income of $32,252.50 or less per year. In New York State, two adults working 40 hours per week for 50 weeks a year at the Minimum Wage make $35,000 annually.
Applying for Medicaid in Erie County Pregnant women, children, disabled persons and others may be eligible for Medicaid if they have a higher income, under certain circumstances. Medicaid can and does cover some costs retroactively, if a person would have been eligible had they applied earlier. Coverage generally stops at the end of the month in which a person no longer meets eligibility requirements.
Selected 2015 Annual Poverty Guidelines & Medicaid Expansion Family Size 100% 120% 133% 150% 200% 1 11,770 14,124 15,654.10 17,655 23,540 2 15,930 19,116 21,186.90 23,895 31,860 3 20,090 24,108 26,719.70 30,135 40,180 4 24,250 29,100 32,252.50 36,375 48,500 5 28,410 34,092 37,785.00 42,615 56,820 In New York State, the Minimum Wage is $8.75 per hour as of November 1, 2015, leading to an annual minimum wage of about $17,500.00. Under the ACA Medicaid expansion, a family of 2 adults and 2 children, with both adults working at minimum wage, absent any special circumstances or additional income, would NOT qualify for Medicaid. ($35,000.00 in income.) The above family would be able to purchase insurance through the NYS Health Plan Marketplace.
Medicaid Costs for 2013 - 2015 2013 2014* 2015# Medicaid Costs $1,485,449,115 $1,625,852,244 $896,559,568 Erie County s Portion of Medicaid Costs The County s final 2015 Medicaid cost is expected to be $8.1 million less than 2014. $217,880,408 $211,425,799 $203,276,191 * The Medicaid Cost data for 2014 is subject to change. # MedicaidCosts are for the period of January 1, 2015 through June 30, 2015. ErieCounty s Portion of Medicaid Costs are projected for the entire Fiscal year 2015.
Medicaid Clients by Year 2012 221,745 2013 230,748 2014 258,819 2015* 252,624 The number of persons on Medicaid in Erie County has been and continues to grow at an average rate of more than four percent (4%) per year. With the increase in Medicaid clients due to the ACA, 2014 Medicaid clients have exceeded 28% of Erie County s population . * 2015 Data covers the period of January 1, 2015 through June 30, 2015.
2015 Medicaid Cost and Client Summary Race/Ethnicity Medicaid Clients 121,313 Medicaid Cost $513,493,591 $232,993,499 $67,405,783 $28,895,369 $5,519,422 $48,251,905 $896,559,569 White Black/African American Hispanic/Latino Asian/Pacific Islander American Indian/Alaskan Native Not Available/More Than One Race Totals 73,780 23,224 12,631 1,827 19,849 252,624 Note: 2015 data is for the period January 1, 2015 through June 30, 2015, and is incomplete. All Medicaid clients self-identify for race and ethnicity. There are more Whites on Medicaid in 2015 than Black/African American, Hispanic/Latino and Asian/Pacific Islander persons combined.
2015 Medicaid Summary by Age Age Group Medicaid Clients Medicaid Cost $148,969,159 $575,014,828 $172,575,582 $896,559,569 65 Years of Age and Older Age 21 64 Age 0 to 20 Totals 21,843 134,377 96,444 252,624 Note: 2015 data is for the period January 1, 2015 through June 30, 2015, and is incomplete. More than one-third of the individuals on Medicaid are under the age of 21.
Medicaid Drugs in Erie County with the Most Filed Prescriptions 2015* Hydrocodone-Acetaminophen: Treats moderate to severe pain Ibuprofen: Over the counter pain reliever Omeprazole: Treats acid reflux Lisinopril: Treats high blood pressure Ventolin HFA: Treats asthma or allergies Atorvastatin Calcium: Treats elevated cholesterol Metaformin HCL: Treatment for type two diabetes Amlodipine Besylate: Treats high blood pressure Levothyroxine Sodium: Treats thyroid deficiency Amoxicillin: Antibiotic Gabapentin: Anti-epileptic medication / pain treatment Aspirin: Over the counter pain reliever * 2015 Data covers the period of January 1, 2015 through June 30, 2015.
2014 Medicaid Clients by Race and Average Income Medicaid Clients in Our Study Race/Ethnicity Average Monthly Income White Black/African American Hispanic/Latino Asian/Pacific Islander American Indian/Alaskan Native Not Available/More Than One Race Totals 38,930 24,938 6,376 2,864 635 7,822 81,565 $1,031.24 955.23 939.56 1,149.43 978.23 950.31 $996.81 A monthly income of $996.81 equates to an annual income of $11,961.72, just above the Federal Poverty Guideline of $11,670 in 2014. The US Census considers Hispanic to be an ethnicity and not a race. Hispanics may be of any race. Please see http://www.census.gov.
2014 Top Five Sources of Income for Medicaid Clients in our Study Monthly Average Income $1,106.00 Top Five Kinds Of Income Salaries and Wages SSI Benefits SS Disability Child Support Payments SS Retirement Monthly Average Income Number of Clients 30,058 23,396 16,400 5,863 5,486 N/A 560.00 825.00 290.00 778.00 $996.81 About 40% of the persons in our study group have earned income (W-2 or a 1099). No total is provided for the number of clients because clients can be counted multiple times.
Summary and Conclusions The Total number of County residents on Medicaid has risen due to the ACA, with more than 28% of residents health insurance now being provided by Medicaid. More than 1/3 of all persons on Medicaid are children (Persons under the age of 21). There are more Whites on Medicaid than Blacks/African-American, Hispanic/Latino and Asian/Pacific Islander clients combined. Erie County s portion of Medicaid has dropped by more than $8.1 million from 2014.
Summary and Conclusions Hydrocodone-Acetaminophen remains the most prescribed drug in Erie County, and has been since 2008. For the Medicaid clients in our study group, the average month income was $996.81. About 40% of the persons in our study group have earned income (a W2 or a 1099). It is a myth that Medicaid clients don t work.
