Medicaid Soars, Covering 1/3 Of New Yorkers

from the New York Sun

By E.B. SOLOMONT

Amid a "historic" increase in statewide Medicaid enrollment, nearly a third of New York City residents are now on the state's rolls, with 1 million joining between 2000 and 2005.

A report published yesterday by the United Hospital Fund documents a 55% increase in statewide Medicaid enrollment, which reached 4.3 million in 2005, up from 2.8 million five years earlier. New York City residents account for 66% of the state's Medicaid program; 2.8 million were enrolled in the program in 2005, up from 1.8 million in 2000.

"It was definitely a major increase," the report's author, Michael Birnbaum, a senior health policy analyst at the United Hospital Fund, said. "Expanding eligibility among adults was one major reason."

Medicaid is the state health benefit program for low-income New Yorkers. With an annual price tag of nearly $47 billion, it is among the costliest nationwide.

The report offered a number of reasons for the statewide enrollment increase, including policy changes and an effort to enroll eligible, uninsured New Yorkers. In the weeks after the terrorist attacks of September 11, 2001, the state offered a Disaster Relief Medicaid program, which temporarily simplified the Medicaid application process for thousands of new enrollees. Around the same time, the state rolled out Family Health Plus, a program for individuals and families with incomes just above the Medicaid cutoff. Simultaneously, the state encouraged managed care plans and community groups to help identify and enroll eligible applicants. Also, a 2001 court ruling allowed certain non-citizens to enroll. In 1997, New York discontinued its coverage of certain immigrant populations, including those with green cards and those in the process of obtaining green cards. Under the 2001 decision, immigrants with green cards or those in the process of obtaining green cards are eligible for state Medicaid benefits.

Undocumented immigrants are not eligible for Medicaid benefits except in emergency situations, or if the undocumented immigrant is a child or a pregnant woman.

Even as the report documented a dramatic increase in enrollment, it found that Medicaid spending grew at an average rate of 7.7%, compared with the 8.2% growth rate for national health care spending. Mr. Birnbaum said the increase in spending was more moderate than the dramatic increase in enrollment because the new enrollees largely did not include those with disabilities or chronic illnesses, whose care can be more costly.

He said the data "puts into sharp focus what a stunning policy success this increase in Medicaid coverage was because without it, there might be a million more uninsured New Yorkers."

In 2005, 2.2 million New Yorkers were uninsured, including 1.2 million in New York City. In 2001, there were 3 million uninsured New Yorkers statewide, including 1.6 million city residents.

At least one analyst suggested that the number of uninsured had remained "relatively flat" during the five-year period, suggesting that some new enrollees sought public benefits instead of private insurance.

"The figure is concerning, particularly when you dig a little deeper and see they did not come from the ranks of the uninsured," a health policy analyst at the Manhattan Institute's Empire Center for New York State Policy, Tarren Bragdon, said. Mr. Bragdon said policy makers pushed people onto Medicaid rolls when they should have been making private coverage more accessible.

"It's not good public policy to switch people from private health insurance to Medicaid, and it's not sustainable, particularly when we go into tight budget times," he said.

State health officials dismissed that notion, saying the "crowd out" number, or the percentage of people switching to public insurance from private, has been "well under" 5% in recent years.

"Your income limits for Medicaid and even for Family Health Plus are so low that the likelihood that any more than a handful of these families had access to employer-sponsored coverage is slim," the state's Medicaid director, Deborah Bachrach, said.

Medicaid eligibility is based on income as it relates to the federal poverty level. Individuals earning up to 80% of the federal poverty level — about $10,400 annually in 2008 — are eligible for Medicaid. Families of three that earn up to 100% of the federal poverty level are eligible.

Under Family Health Plus, individuals are eligible for public health benefits if they earn up to 100% of the federal poverty level. Families are eligible if parents earn up to 150% of the federal poverty level. Under the State Children's Health Insurance Program, children whose family income does not exceed 250% of the federal poverty level are eligible.

Nearly 6 million New Yorkers were enrolled in Medicaid, Medicare, or other forms of public health insurance in 2006, according to the most recent data from the Kaiser Family Foundation. The population at that time was just more than 19 million statewide.

As part of an effort to insure more New Yorkers, the state has made a concerted effort to enroll eligible New Yorkers in public health insurance programs. In 2007, New York proposed increasing the family income limit for SCHIP to 400% of the federal poverty level.

Last month, state health officials rolled out a $10 million advertising campaign to encourage Medicaid enrollment. The agency is using radio and television spots, as well as posted signs in subways, Laundromats, and check-cashing stores.