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The Nelson A. Rockefeller Institute of Government

Health Care: Long-Term Care

Long-Term Care

Paying for Long-Term Care: Families or Taxpayers?

Long-term care represents one of the largest and fastest-growing costs in Medicaid, the government health insurance program intended for low-income people. Much of the cost in the last several decades has derived from more affluent people transferring their assets to heirs before their death; this reduces their personal net worth, qualifies them for Medicaid and requires the public program to cover their nursing home or home-care expenses. At this Institute public policy forum, experts discussed a public-private effort in New York — the New York State Partnership for Long Term Care — that encourages state residents to purchase insurance to cover their long-term care expenses and guarantees they will not need to sell off their assets if the insurance runs out.
December 6, 2010

Room for Interpretation: Causes of Variation in County Medicaid Asset Transfer Rates, Opportunities for Cost Reduction

New York State’s assumption of county Medicaid administration could reduce costs, but big savings will depend on improved administrative processes, according to this Institute report. The report examines differences in Medicaid nursing home eligibility denials among counties as an illustration of the challenges the state will face in taking over administration of Medicaid.
Courtney E. Burke, with Barbara Stubblebine and Kelly Stengel, August 2010

Medicaid Policy and Long-Term Care Spending: An Interactive View

Institute experts have applied an interactive measure that proves better at explaining wide variations in states' long-term care spending than individual measures analyzed in previous research. The index considers multiple factors, including coverage policies, nursing home payment rates and others. It may assist states in developing new policies to enhance care for elderly and disabled residents, while limiting costs.
James W. Fossett and Courtney E. Burke, August 2010

Long-Term Care in Albany County: An Overview

The future of long-term care was discussed during an Albany, N.Y., community forum sponsored by the League of Women Voters and moderated by the director of the Institute’s Health Policy Research Center, Courtney Burke. Burke provided an overview of demographic trends, aging services, Medicaid long-term care expenditures, and challenges for Albany County’s long-term care system. The forum, which was attended by over 150 people, also included remarks from Richard Iannello, executive director of the Albany Guardian Society; Carmen Mazzotta, president of Health Capital Partners; Simeon Goldman, senior staff attorney for Disability Advocates Inc.; Lois Wilson of Capital District Senior Issues Forum; and June Maniscalco of the Albany County Nursing Home Family Council.
Courtney Burke, June 10, 2009

Assessing Asset Transfer for Medicaid Eligibility in New York State

New Rockefeller Institute research examines the transfer of personal financial assets by New Yorkers seeking to have Medicaid pay for nursing home care. About 7 percent of such applications were rejected from 1998 to 2008 because applicants had transferred assets to family members or others within a few years of requesting Medicaid coverage, the study finds. Counties throughout the state varied widely in the percentage of applicants they rejected because of such asset transfers.
Rockefeller Institute of Government, March 2009
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Medicaid and Long-Term Care: New York Compared to 18 Other States

New York’s Medicaid program spends more on long-term health care than any other state, but indicators of quality are only about average or slightly above average. This study compares New York to 18 other large or Northeastern states.
Rockefeller Institute of Government, February 2009
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Federalism by Waiver: Medicaid and the Transformation of Long-Term Care

This article focuses on 1915c program waivers, which gave states the opportunity to overcome Medicaid's institutional bias by offering more home and community-based services. The use of this tool has fueled deinstitutionalization and other program changes. It reflects the rise of executive federalism — the growing tendency for major program decisions to shift from the legislative arena to the executive branch of the national and state governments. By functioning as licenses, the 1915c waivers take devolution via the administrative process to new levels. The proliferation of these waivers suggests a need to revise prior conceptions of federal–state relations, such as picket fence federalism.
Frank J. Thompson and Courtney Burke, Publius: The Journal of Federalism, Vol. 39, No. 1, Winter 2008

Aging in the Community and Long-Term Care

Courtney Burke, director of the Institute's Health Policy Research Center, presented information on this issue for a forum sponsored by the New York State League of Women Voters on March 20, 2009. The event, which was attended by over 100 people, also include presentations from Michael Burgess, Commissioner of the State Office for Aging, and Mark Kissinger, Deputy Commissioner for Long-Term Care.
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New York's Institution-Centered System for the Provision of Health Care

New York differs from other states in terms of where people receive health care and how much it costs. Compared to other states, New Yorkers, and particularly those enrolled in publicly funded health insurance programs like Medicaid, Child Health Plus, and Family Health Plus, receive more care more often in institutional settings.
Courtney Burke, May 2007

Medicaid and Long-Term Care: Where New York Stands

Presentation at the Ninth Binghamton Symposium on Health Care Management & Policy, Binghamton, NY.
Courtney Burke, May 10, 2007

Point of Entry Systems for Long-Term Care: State Case Studies

This report was prepared to inform the New York City Department for the Aging about other states' long-term care (LTC) point of entry (POE) systems. The analysis and case studies in this report focus on the following topics: system structure and integration at the state and local levels, common elements of successful systems, and special features of each POE system.
Allison Armour-Garb, prepared for the New York City Department for the Aging, April 2004