The purpose of Medicaid is very simple and compassionate: people who cannot afford health insurance or have a disability should be able to receive medical care when they need it. The working reality is more complex. Medicaid was created in 1965 along with Medicare for the elderly as part of the social safety net. Its recent history and current issues can be found at the New York Times website. It has three major components:
1. Health insurance for poor people, including parents with low incomes and their children.
2. Long-term care for the elderly.
3. Coverage for people with disabilities.
Most Medicaid beneficiaries are low-income adults and children, but the largest portion of spending goes to care for the elderly and disabled. The non-elderly adult has annual health care expenses of around $4,000 while elderly and disabled enrolees commonly incur costs over $20,000. Long-term care may be even more expensive.
Unlike Medicare, a national health insurance program with both private and public plans available for purchase, Medicaid is an entitlement and a federal / state partnership. States may participate voluntarily – all of them do – and each develops its own structures and services with the cost shared between the Federal and State governments -- the federal government now covers about 57%. In a handful of states, some Medicaid costs are also picked up by county governments. New York is one of those states. Information for New York residents on eligibility can be found here.
In 2007, more than five million New York residents were signed up for Medicaid and the cost of their care came to more than $40 billion, the highest in the nation. The county share statewide is $7 billion (about 16% of the total) and that is customarily drawn from the county property tax. Health care costs continue to rise nationally and New York's Medicaid program has been expanded until paying for Medicaid has come to absorb about three-quarters of the property tax in many counties. Medicaid eligibility and funding are complex. (That complexity is blamed by some New York officials for improper claims and overbilling from 1990 to 2001 that led to the state being obligated to repay over $500 million to federal government.) Given the recent economic downturn the Medicaid rolls have climbed.
To address current Medicaid policies in New York State and proposals for the future, WSKG's "Community Conversation" brings together three persons with extensive professional experience and personal familiarity with New York's Southern Tier region and its needs.
Thomas J. Santulli is County Executive of Chemung County and president-elect of the New York State Association of Counties. He has been a leading advocate for eliminating the requirement that counties cover Medicaid costs , and also an innovator in providing services to Medicaid recipients. Chemung County is currently moving forward with plans for a Medicaid clinic (called a Medicaid Community Medical Home) in Elmira that will serve about 4,000 of Chemung County's 17,000 Medicaid recipients.
James R. Tallon, Jr. is president of the United Hospital Fund of New York , which includes the Medicaid Institute . He also chairs the Kaiser Family Foundation Commission on Medicaid and the Uninsured . Mr. Tallon was State Assemblyman from the Binghamton area from 1975-1993, served as Democratic Majority Leader from 1987-93 and chaired the Assembly Health Committee.
William F. Streck, M.D . is President and Chief Executive Officer of Bassett Healthcare . Based in Cooperstown, Bassett operates five hospitals, thirteen school-based clinics and two dozen community outpatient centers and is affiliated with the medical school at Columbia University. Dr. Streck, an endicronologist, chairs the Public Health Council of New York and is past chairman of the Healthcare Association of New York State. Bassett Healthcare and its policies concerning physician compensation was the subject of a New York Times article on July 25th.