Medicaid's Effect on the Elderly: How Reimbursement Policy Affects Priorities in the Nursing Home

Abstract

This article examines the social impact of Medicaid policy on the elderly in long-term care and identifies a previously unrecognized problem produced by Medicaid in New York State. Recent fieldwork in proprietary nursing homes in New York City shows that this state's Medicaid system results in a selection hierarchy on admissions and within nursing homes not only in terms of sponsor of payment but also in value, based on residents' functional level. Specifically, New York State Medicaid's Resource Utilization Groups (RUGs II) system is responsible for a new and startling phenomenon in long-term health care of the elderly: the creation of "minihospitals" in lieu of traditional skilled nursing facilities. This problem indicates the complex ways in which reimbursement policy drives priorities in nursing homes and creates unintended negative outcomes. In light of this consideration, various policy alternatives to Medicaid that would improve the plight of the elderly in long-term care are suggested and evaluated.

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References

Binstock, R. (1989, January 2). The phantom old-age vote New York Times, 23.

Bovbjerg, R.R. , & Holahan, J. (1982). Medicaid in the Reagan era: Federal policy and state choices. Washington, DC: Urban Institute Press.

Crystal, S. (1982). America's old age crisis: Public policy and the two worlds of aging. New York: Basic Books.

Feder, B.J. (1988, December 11). What ails a nursing home empire. New York Times, 1.

Grimaldi, P.L. (1982). Medicaid reimbursement of nursing home care. Washington, DC: American Enterprise Institute for Public Policy Research.

Hollie, P. (1984, September 15). Nursing homes seek affluent. New York Times, 31.

Institute on Law and Rights of Older People. ( 1986). Criteria for aging. New York : Brookdale Center on Aging.

Jones, M. (1984, March 11). When it's time for a nursing home. New York Times, 20.

Lammers, W.W. (1983). Public policy and the aging. Washington, DC: CQ Press.

10.

New York State Health Planning Commission with New York's Health and Human Service Agencies. (1982). New York State medical assistance program: Past, present, and future. Albany: State of New York.

11.

Pear, R. (1988, January 17). New law protects rights of patients in nursing homes. New York Times, 1.

12.

Rudder, C. (1988). Reimbursement and the nursing home resident: Resource utilization groups. Albany: State of New York.

13.

Sidel, R. (1986). Women and children last: The plight of poor women in affluent America. New York: Penguin.