Medicaid is a joint federal – state health insurance program that assists those persons with low income and limited resources. In New York State, the State government requires county governments to administer and provide Medicaid services and to pay a portion of the cost of Medicaid. Until 2006, counties generally paid 25% of the total cost of Medicaid, the State paid 25%, and the federal government paid 50%. This was not an exact ratio of county share expense, as certain adjustments to the funding formula, including in long term care and nursing home expense starting in 2004 reduced county share expense.
For example, long term care expenses, a very large portion of Erie County’s Medicaid costs, began moving out of the county share in 2004, thus lowering Erie County’s overall share of the expense. The Nursing Home category and Home Health services category made up 41% of the total Medicaid program expenses for Erie County in 2011. As the expense for these services was moved from the county share, the percentage of the county share correspondingly reduced over time. There are also populations for which Erie County is responsible for a lower share of the cost of Medicaid, such as Native Americans.
Presently, due to these various funding adjustments and also due to the State’s “Medicaid Cap” process, the Erie County share of Medicaid expense is approximately 15%. That said, the County’s annual expense for Medicaid-MMIS is still the single-largest appropriation account in our operating budget. . These statistics and data do not include any intergovernmental transfer (“IGT”) payments required under federal law and regulations to be made by the County for the benefit of Erie County Medical Center Corporation.
Medicaid became law in 1965. It is often confused with Medicare. Medicare is a federal health insurance program that helps the elderly and disabled. It is possible to qualify for both programs. In that case, Medicaid typically pays the Medicare coinsurance and deductibles. Medicaid has a core of services mandated by the Federal government and optional services the states can cover or provide if they so choose. New York State covers nearly all the optional services for Medicaid.
Medicaid services can be provided in one of three ways – Fee for Service, Rate, and Managed Care. Fee for Service is a process where Medicaid providers are paid a fee for the service provided. The fee is based upon a set maximum price for units of service. Rate providers are paid a threshold rate based upon cost report data submitted annually to the New York State Department of Health. There are other reimbursement formulas for Rate providers and the rate can vary daily, monthly or annually. In Managed Care, Managed Care Organizations (“MCO”) are paid a monthly capitation payment for each enrolled member to coordinate the provision, quality and cost of care for these enrolled members.
Below are some key Medicaid data points for selected years and ending with 2018. More detail on Medicaid, Medicaid expenditures within Erie County and Erie County Medicaid recipients can be found in the 2018 Medicaid Report generated by this office. See the section maked "Latest News".
|The Medicaid Drugs in Erie County with the Most Filled Prescriptions are:|
|2015||2016||2017 A||2018 A|
|1||Hydrocodone-Acetaminophen||Ibuprofen||Atorvastatin Calcium||Atorvastatin Calcium|
|5||Atorvastatin Calcium||Lisinopril||Metformin HCL||Metformin HCL|
|6||Ventolin HFA||Metformin HCL||Ventolin HFA||Gabapentin|
|7||Metformin HCL||Ventolin HFA||Hydrocodone-Acetaminophen||Amlodipine Besylate|
|8||Amlodipine Besylate||Amlodipine Besylate||Amlodipine Besylate||Ventolin HFA|
|9||Levothyroxine Sodium||Levothyroxine Sodium||Gabapentin||Levothyroxine Sodium|
|All Prescriptions Filled||3,036,661||3,190,990||3,285,789||2,168,147|
|Just Above Scripts Filled||646,910||676,377||674,190||448,132|
|Percent of Total||21.30%||21.20%||20.52%||20.67%|
|A The 2017 and 2018 data are not final. 2018 data reflects the period January 1, 2018 through September 21, 2018.|
|Drug Name||Commonly prescribed for:|
|Amlodipine Besylate||High blood pressure treatment|
|Amoxicillin||Infection treatment (Antibiotic)|
|Aspirin||Over the counter pain reliever|
|Atorvastatin Calcium||Elevated cholesterol treatment|
|Clonazepam||Epilepsy treatment and treatment for bipolar disease and panic attacks|
|Gabapentin||Anti-epileptic medication and treatment for some kinds of nerve pain|
|Hydrochlorothiazide||Treatment for high blood pressure, also osteoporosis and is a diuretic|
|Hydrocodone-Acetaminophen||Treatment for moderate to severe pain|
|Ibuprofen||Over the counter pain reliever|
|Levothyroxine Sodium||Treatment for thyroid deficiency|
|Lisinopril||High blood pressure treatment|
|Loratadine||Treatment for allergies|
|Metformin HCL||Treatment for type two diabetes or pre-diabetics|
|Omeprazole||Treatment for acid reflux|
|Ventolin HFA||Treatment for asthma or allergies|
|Vitamin D||Addresses bone loss and cognitive impairment|