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.

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 2019.  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:
  2016 2017 2018 2019 A
1 Ibuprofen Atorvastatin Calcium Atorvastatin Calcium Atorvastatin Calcium
2 Omeprazole Ibuprofen Ibuprofen Ibuprofen
3 Hydrocodone-Acetaminophen Omeprazole Omeprazole Gabapentin
4 Atorvastatin Calcium Lisinopril Lisinopril Lisinopril
5 Lisinopril Metformin HCL Ventolin HFA Omeprazole
6 Metformin HCL Ventolin HFA Gabapentin Metformin HCL
7 Ventolin HFA Hydrocodone-Acetaminophen Metformin HCL Amlodipine Besylate
8 Amlodipine Besylate Amlodipine Besylate Amlodipine Besylate Levothyroxine Sodium
9 Levothyroxine Sodium Gabapentin Levothyroxine Sodium Albuterol Sulfate
10 Gabapentin Levothyroxine Sodium Hydrocodone-Acetaminophen Hydrocodone-Acetaminophen
11 Amoxicillin Amoxicillin Vitamin D Vitamin D
12 Aspirin Vitamin D Sertraline HCL Sertraline HCL
         
All Prescriptions Filled                                      3,190,990 3,278,086                                      3,250,151                                      1,681,172
Just Above Scripts Filled                                         676,377                                         667,229                                         668,071                                         335,584
Percent of Total 21.20% 20.35% 20.56% 19.96%
         
A 2019 data covers the period January 1, 2019 through June 30, 2019 and is not final.       

 

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