Taxpayers spend around $8 billion annually in New York for nursing home care for the elderly and disabled—most of it through Medicaid. Increasingly, the state is using managed care companies to oversee the treatment residents receive in nursing homes and hospitals, and starting next year these intermediaries will manage all incoming nursing home residents.
State officials hope turning to companies, like Aetna, United, and Catholic Health Services will save money and improve quality, but many consumers and advocates say New York is not setting high enough standards for managed care companies and is not monitoring nursing homes closely enough.
"The Department of Health says any facility that is licensed in New York State is deemed to be providing quality services, but that's clearly not the case," said Richard Mollot, from the Long Term Care Community Coalition.
Mollot's organization recently released a study of the emerging managed care program and found several companies using poor performing nursing homes in their networks. Sixty-four homes with current or recent lawsuits were being used by managed care companies, and 13 homes designated Special Focus Facilities for close monitoring by federal authorities are also in these networks.
The state says people can always change from one managed care program to another.
About 108,000 New Yorkers live in nursing homes, more than in any other state.
The new rule taking effect in January will only require future, not current, nursing home residents to go through managed care companies. It will be phased in over two years.