More Problems with New York Medicaid Overpayments

We are in the midst of significant changes to the New York Medicaid system. The critical state-federal program serves as a lifeline for many residents–including those in nursing homes. As part of President Obama’s healthcare overhaul, Medicaid is expanding, opening opportunities to more residents than ever before. New York has been cited as a model for that expansion, as our state has the most robust system in the country.

At the same time, however, with expansion comes increased scrutiny on exactly how each Medicaid dollar is spent. Both state officials and federal regulators are focusing on cutting out fraud and otherwise maximizing the value of funds. While this may seem like only a concern of policymakers, these changes will also trickle down and directly affect New York residents who rely on the system. As oversight changes, there may be alterations to the Medicaid application process and new rules about what benefits a resident can receive as part of the system.

More Overpayments
Last week federal officials released a report which suggests that New York was given $320 more in federal Medicaid payments that it was actually entitled. The problem apparently goes back several years and stems from the billing practices at state-run facilities for the disabled. The U.S. Department of Health and Human Services inspector general’s report notes that the facilities were billing at nearly doubly the appropriate rate.

This problem was first identified in 2012, and state officials have already implemented various changes in order to address the issue. For example, a new payment system was created and applied retroactively. New payment plans are being negotiated with federal officials.

On top of that, mirroring general trends in elder caregiving, state reliance on institutions for disability care is decreasing. Consider that in 1990 there were around 27,000 developmentally disabled residents in state-run facilities–today there are less than 1,000. Instead, individuals in need of this support are being moved to community care and group homes.

Federal officials note that more audits of the NY Medicaid system are on the way. The audit manager specifically indicated that an analysis of community support programs offered by Medicaid will be looked at next to ensure all funds spent are being used as intended.

NY Medicaid Attorneys
Navigating the Medicaid maze is a daunting challenge. Fortunately, elder law attorneys can help you put a plan in place to prepare for potential Medicaid enrollment and save assets in the process. Contact a professional today to see how we can help.

Contact Information