Room for Interpretation: Causes of Variation in County Medicaid Asset Transfer Rates, Opportunities

This NYHealth-funded report, prepared by the New York State Health Policy Research Center — a program of the Nelson A. Rockefeller Institute of Government — analyzes Medicaid administration at the county level, in particular, determination of eligibility for Medicaid coverage of nursing home care.

Legislation enacted as part of the 2010-11 New York State budget requires the State to assume control of Medicaid administration and costs from counties. Administrative costs for Medicaid are estimated at $1.1 billion annually. The report highlights steps the State could take to begin the process of centralization, as well as other ways to reduce costs both through administrative and policy changes.

This report follows up on a 2009 NYHealth-funded report, Assessing Asset Transfer for Medicaid Eligibility in New York State, which found counties widely differ in their denial rates for Medicaid nursing home care due to asset transfers. The second report seeks to identify potential causes of this variation. It features the results of interviews with local officials in selected counties regarding eligibility procedures and other factors related to long-term care determinations. The report identifies differences in administrative processes that may account for differences in denial rates. Analysis compared counties that were similar in population and income but different in their rates of denial. It was found that although administrative variation among counties was extensive, the differences were not clearly related to denial rates.