What Is Medicaid

MEDICAID

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
2 Ibuprofen Omeprazole Ibuprofen Ibuprofen
3 Omeprazole Hydrocodone-Acetaminophen Omeprazole Omeprazole
4 Lisinopril Atorvastatin Calcium Lisinopril Lisinopril
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
10 Gabapentin Gabapentin Levothyroxine Sodium Hydrocodone-Acetaminophen
11 Aspirin Amoxicillin Amoxicillin Vitamin D
12 Amoxicillin Aspirin Vitamin D Amoxicillin
         
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

 

Contact

Phone: (716) 858-4639
Fax: (716) 858-4629

Erie County Medicaid Inspector General
Edward A Rath County Office Building
95 Franklin Street, Room 802
Buffalo, New York 14202