2015 Office of Erie County Medicaid Inspector General Report Reveals Continuing Rise in Medicaid Usage

Modified: November 12, 2015 3:52pm

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Poloncarz Unveils Medicaid Report

Erie County Executive Mark Poloncarz and Medicaid Inspector General Michael Szukala unveil the 2015 General Report.

Over 28% of County Residents’ Health Insurance Provided by Medicaid; Over One-Third of Recipients are Under Age 21, More Whites Enrolled than Blacks, Hispanics and Asians Combined

Growth Continues At Over 4% Per Year; Hydrocodone-Acetaminophen Retains Top Spot as Most-Filled Prescription

ERIE COUNTY, NY— Today, Erie County Executive Mark C. Poloncarz and Erie County Medicaid Inspector General Michael Szukala reviewed the findings of a recent 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 – June 30, 2015.

The report is the third in a series examining Medicaid usage in Erie County and reveals that the total number of county residents on Medicaid has risen due to the Affordable Care Act (“ACA”), with more than 28% of Erie County residents’ health insurance now being provided by Medicaid; if current trends continue, more than a third of Erie County residents will be on Medicaid by the year 2021.  Among other findings, the report also revealed that over one-third of Medicaid recipients are under the age of 21, that the number of enrollees continues to grow steadily at an average annual rate of more than 4%, and that in 2015 there are more Whites on Medicaid in Erie County than Blacks/African-Americans, Hispanics/Latinos and Asians/Pacific Islanders combined. The full report can be read here.

“The information contained in this report both illustrates continuing trends in Medicaid usage in Erie County and how the average recipient has changed since passage of the Affordable Care Act. We are continuing to see increases in the number of Medicaid recipients less than 21 years of age and in the number of white recipients, even while actual Medicaid costs to the county decrease as a result of the ACA’s reimbursement formula,” said Erie County Executive Mark C. Poloncarz. “Also, while more than 28% of our county’s residents now receive their health insurance from Medicaid, that number is projected to rise to over 33% by 2021 if trends continue. Poverty is a very real problem in Erie County and we remain committed to addressing it.”

Among its many findings, the report notes that Erie County’s portion of Medicaid costs has fallen more than $8.4 million since 2012 as a result of the implementation of the ACA, while the categories of care showing the most significant cost increases continue to be Managed Care, Home Health, and Nursing Home Care. Cost increases across these three categories have progressed since New York State moved more individuals to managed care in 2011, and these three categories remain by far the three largest areas of Medicaid expenditures.

The 2015 report also showed continuing demographic trends among Medicaid recipients. Since 2010, Whites are the race/ethnic group with the largest increase in Medicaid recipients and for the period 2010-2014, Whites in the age group 21-64 became Medicaid recipients nearly five times faster than Blacks or Hispanics. Correspondingly, the most Medicaid claims by race are filed by Whites and Whites also account for the highest average cost per Medicaid client.

“The data in this report highlights so many issues,” said Szukala. “Things such as obesity, after diabetes, the second most treated metabolic/nutritional condition covered by Medicaid.  Childhood obesity rates have been rising nationwide, and Erie County’s Medicaid population is no exception.”      

Medicaid is a means-tested program, with acceptance into the program based heavily on an individuals’ monthly income. In 2014, the MIG report showed that over 70% of Medicaid recipients in Erie County had some form of outside income. The 2015 report expands on the work done in 2014 by examining over 172,000 Medicaid recipients who are over the age of 18 and found that the average monthly income for this group is $996.81, which equates to an average annual income of $11,961.72. In 2014, the federal poverty guideline for an individual was $11,670, and that individual qualified for Medicaid with an income below $15,521.10.

“This report shows again this year that many Medicaid recipients are employed outside of the home but are still not earning enough to rise above the qualification threshold.  These individuals are not the lazy, unemployed stereotypes that many people have of Medicaid recipients, but rather are doing all they can to provide a better life for themselves and their families,” Poloncarz added. “We continue to see that Medicaid is expanding with more usage 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.”

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 Hydrocodone-Acetaminophen, which has held the top spot for three years and is also the most abused painkiller in America.

The MIG team’s three employees are funded by New York State under a 2012 agreement. Since its inception in 2012, the Erie County Office of the Medicaid inspector General has completed or is in the process of completing 23 audits covering more than $80 million in Medicaid payments. This includes audits of transportation providers, pharmacies, assisted living program providers and durable medical equipment (“DME”) providers. The results of these audits have been submitted to the New York State Office of the Medicaid Inspector General for follow-up.



For more information:

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