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9/12/13: Analysis of County Medicaid Usage Reveals Steadily Rising Costs and Enrollees, Demographics of Recipients


Report from Office of the Medicaid Inspector General Shows Large Number of Children Receiving Assistance

County’s Medicaid Cost for 2013 Estimated at More Than $219 Million

ERIE COUNTY, NY— Today, Erie County Executive Mark C. Poloncarz and Erie County Medicaid Inspector General Michael Szukala reviewed the findings of a report issued by the Erie County Medicaid Inspector General’s Office (“MIG”) that analyzes Erie County Medicaid data for the period January 1, 2008 – April 30, 2013. The report, the first of a series of reports examining Medicaid in Erie County, outlines the county’s total actual cost of Medicaid by medical category during this period.  Total Medicaid costs in 2011 amounted to $1,408,612,250, of which Erie County’s portion was $206,406,373. In 2012, total Medicaid costs rose to $1,426,579,102 while Erie County’s portion rose to $211,765,441.  In 2013, total Medicaid costs through April 30 have reached $462,849,606, with Erie County’s portion estimated to rise to $219,748,429 by year’s end.

The report also reveals the number of Medicaid recipients by age and race, the growth rate of enrollees per year, the average cost per enrollee per demographic group, and the top twelve local zip codes for number of recipients. 

“This report is important for a number of reasons, and I commend Inspector General Szukala and his team for their diligence and meticulousness in compiling this data. Not only does this first of its kind report illustrate the annually increasing cost of Medicaid in Erie County, it also puts a face on who is enrolled in the program, and we are seeing that a significant portion of recipients throughout Erie County are children,” said Poloncarz. “In 2010, three of every ten children in Erie County were receiving Medicaid assistance, while overall more than one out of five county residents, 22%, was receiving Medicaid. The report also shows that the number of persons on Medicaid is increasing at an average rate of more than 4% annually. These numbers paint a sobering picture of the realities of poverty in our community and the primary reason for increasing costs in the program.”

The report’s analysis shows that Medicaid recipients are located throughout Erie County, not just in the City of Buffalo, and that a growing number of clients reside in suburban towns such as Amherst, Cheektowaga and Tonawanda. Other findings include: 13% of all persons identified as White/Caucasian in Erie County were on Medicaid in 2010, compared with 52% of African-Americans and 42% of Hispanic/Latinos, and 16% of White/Caucasian children were on Medicaid, compared with 63% of African-American children and 45% of Hispanic/Latino children. Alarmingly, the data also showed that in 2010, 40% of all African-American Medicaid recipients, 44% of Hispanic/Latino recipients, and 28% of White/Caucasian recipients were children.

The report also notes that while persons identified as White/Caucasian make up 44% of the Medicaid population, 60% of total Medicaid dollars were spent on White/Caucasian enrollees in 2010. In fact, in 2010, the average cost for a White/Caucasian Medicaid recipient was $8,527.00 while it was $4,825.20 for all other racial groups. The report also revealed that the average cost per Medicaid recipient in 2010 was $13,497 for those 65 and older, $7,818 for adults between the ages of 21 and 64, and $2,968 for those under the age of 21.

The report also identifies the top 12 prescribed drugs for recipients in 2010-2013 and finds that the number one prescribed drug to Medicaid recipients for all years has been Hydrocodone-Acetaminophen, which is more commonly known as Vicodin or Loratab.

Poloncarz continued, “Medicaid is a means-tested program, available to those who meet stringent income and eligibility guidelines.  The knowledge that so many meet these guidelines, and so many are children, is a sobering reminder of how much poverty exists in Erie County.  Regardless of where you live in Erie County, poverty isn’t far away. The number of children receiving Medicaid should give anyone pause, and shows that it is truly the most vulnerable among us who are in the greatest need. Additionally, I am concerned by the significant discrepancy between increased spending on Whites/Caucasians versus all other racial groups. I have ordered the Office of Medicaid Inspector general to determine why this is the case so that we may work to create a more equal healthcare system for all in the future.”

Michael Szukala, head of the Medicaid Inspector General Team, added “With 30% of the children in Erie County receiving Medicaid assistance, and the total number of recipients growing by 4% annually, it is easy to see why the current system is strained. Access to the New York State Medicaid Data Warehouse gives Erie County real-time information on Medicaid activity, such as the most commonly prescribed drugs for Medicaid patients.  This information allows Erie County, specifically the MIG team, to focus audit work on areas of high or low usage, patterns of unusual usage, or high Medicaid cost. This will help the county and New York State to better manage its Medicaid costs and root out waste, fraud, and abuse in the program that other wise deprives needy citizens of the high-quality healthcare they deserve.” 

Since September 1, 2012, operating under agreements with the NYS Office of the Medicaid Inspector General (“OMIG”), the Erie County MIG team has completed six audits covering over $38.2 million in Medicaid payments. The results of those audits have been submitted to OMIG for follow-up and action by NYS. Three additional ongoing audits cover more than $13 million in Medicaid payments.

Click here to read the report , poverty guidelines, Medicaid data map, and Medicaid map percentages by zip code, or view the PowerPoint slide show.