11/5/14: Analysis of EC Medicaid Usage Reveals Rising Percentage of New Enrollees, Particularly Children, Across County While County Share of Program is Lower

Modified: January 23, 2015 3:24pm

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Office of Medicaid Inspector General Report Also Shows 71% of Medicaid Recipients in County Are Employed or Have Source of Outside Income While Enrollment Continues to Climb due to the Affordable Care Act’s Medicaid Expansion, EC Medicaid Costs Fall; Increase Noted in White Recipients 

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 selected Erie County Medicaid data for the period January 1, 2011 – September 18, 2014. Major findings of the report, the second in a series of reports examining Medicaid usage in Erie County, revealed that more than 25% of Erie County residents’ health insurance, including a growing number of children, is now provided by Medicaid and that fully 71% of all Medicaid recipients in Erie County have some source of outside income, usually but not exclusively employment-related. The full report can be read here.

Among other findings, the report also revealed that while the total number of County residents on Medicaid has risen due to fuller implementation of the Affordable Care Act (“ACA”), Erie County’s portion of Medicaid costs is projected to drop by more than $6.4 million from 2013 due to the Act’s implementation and the state’s Medicaid cap, and is approximately $340,000 less than 2012; the biggest increase in Medicaid recipients was seen among whites age 18-64, while other demographics remained consistent; and that the number of persons on Medicaid continues to grow at an average rate of more than 4% each year, a trend noted by the Medicaid Inspector General’s office in his September 2013 report.

“This data shines a new light on Medicaid usage in Erie County and that light reveals some interesting facts. In 2010, 30% of the County’s children under the age of 18 were covered by Medicaid, while in 2014 that has risen to 41% due to the expansion of Medicaid under the Affordable care Act. Though the number of recipients has increased, as was expected due to the implementation of the ACA, actual cost to the County has gone down as a result of the Act’s new reimbursement formula, meaning more people are being provided health insurance in our county but at a less expensive cost than before,” said Poloncarz.

“Moreover, the largest increases in Medicaid usage are being seen in the white population, as enrollment among whites age 18-64 rose by over 7,000 people between 2012- 2014, while enrollment for whites under the age of 18 rose by nearly 4,000 in the same period,” Poloncarz added. “Additionally, this report shows that more than 7 in 10 Medicaid recipients have some form of outside income, usually a low-paying or minimum-wage job that still isn’t enough to lift them over the poverty threshold. This is a wakeup call to everyone who thought that Medicaid recipients were unemployed. Many are gainfully employed in a full-time job, but are still not making enough to provide for the healthcare needs for themselves and their families.”

The report’s analysis demonstrates that while Medicaid recipients reside everywhere in Erie County, the top twelve zip codes for Medicaid usage can be found in the City of Buffalo, the City of Lackawanna, the Town of Cheektowaga, and parts of the City and Town of Tonawanda. From 2010 through 2013, the number of Medicaid clients has increased by 26,005 people, with the majority of that increase in persons under the age of 18. Significantly, it is white enrollees who are driving the increases in Medicaid usage, as the number of whites age 18-64 enrolled in Medicaid has gone up from 62,758 in 2012 to 69,995 in 2014 YTD. For whites under the age of 18, the number has risen from 29,174 in 2012 to 33,054 in 2014 YTD.  Other race and age demographics have remained largely the same in this period.

The report also sheds light on Medicaid enrollees and employment, showing that 71% of recipients across Erie County report some form of outside income, usually a minimum-wage job but that may also be alimony, pension, or some other form of passive income. These recipients are the heads of households and are responsible for people other than themselves in their homes.

“Taken together, these findings shatter the popular stereotype of Medicaid recipients as lazy individuals sitting at home and watching TV rather than working to provide for themselves,” Poloncarz added. “We are seeing that Medicaid is expanding with more usage than was previously thought in the white community in Erie County, and also that many recipients are working to pay the bills and put food on the table but still need help from the Medicaid system to provide for their families’ healthcare needs. This shows that the Affordable Care Act is working and more people are being covered in Erie County than before.”

In addition to the above findings, the report also showed that the top four prescriptions most commonly filled in Erie County through Medicaid have remained the same since 2012, including #4 Lisinopril, #3 Omeprazole, #2 Ibuprofen and #1 Hydrocodone-Acetaminophen. However, the number of filled hydrocodone prescriptions also fell 9% since I-STOP legislation was implemented in August 2013. Other findings revealed in the report identified increases in Medicaid costs for Managed Care, Transportation, and Intermediate Care Facility for Persons with Mental Retardation, all areas that are expanding as New York State moves more individuals to managed care; and increases in Medicaid spending on mental health-related diagnoses.

Michael Szukala, head of the Medicaid Inspector General team, added, “Clearly, this report shows that not only does the need for Medicaid support continue to grow, but that it is growing in sectors of our community that people might not expect. More and more whites and working people are enrolling all across Erie County, while other demographics remain consistent or are even dropping in some instances. Medicaid is a means-tested program, so to see the way in which it is growing should be an eye-opener for anyone who thought they knew all about the program and who’s using it.  Regardless of where you live in Erie County, chances are that someone on Medicaid isn’t far away.”

For more information:

On the Office of the Medicaid Inspector General, visit http://www2.erie.gov/medicaid/