NY Times: Adult Day Centers Blur Medicaid Eligibility

In New York City, adult day care centers provide seniors with community-based services, while simultaneously blurring the line for Medicaid eligibility, according to a New York Times article.

To receive the benefits of Medicaid, individuals must be impaired enough to require at least 120 days of help with activities such as walking, bathing and even getting dressed in the morning.

Seniors visiting New York’s adult day centers do not seem to fit this description, as the Times article notes several instances where older people participated in “vigorous” games of table tennis and billiards at such centers, some of which left on bicycles with bags of carry-out food in hand.

Neither a wheelchair nor a walker was in sight at these adult day centers, observed the Times, yet the cost of attendance was indirectly being paid by Medicaid under Governor Andrew M. Cuomo’s $2 billion in spending on long-term care meant for the impaired elderly and those with disabilities.

Because of little regulation and oversight, these centers have experienced a boom in the past two years, growing from just eight programs for people with dementia to at least 192 businesses across the city, the article writes.

The centers are paid by managed care companies, having collected over $25 million from managed care plans in the first nine months of 2012, at roughly $93 per person, according to the New York Times.

Medicaid then pays these managed care companies, where in New York City, the rate is approximately $3,800 a month per member.

“The whole thing is going to end up costing the state much more money,” said Valerie Bogart—a lawyer with New York Legal Assistance Group—to the New York Times. “It’s really up to the managed care plans to be the watchdogs now, and it’s like the fox watching the chicken coop, because they have an incentive to make money from these centers, too.”

The state’s Medicaid redesign process, spearheaded by Gov. Cuomo, transferred tens of thousands of recipients of long-term care to a new system in which providers bill Medicaid for each service to managed care. A capped monthly rate is then required to cover all services to a company’s enrollees.

While some argue that without socialization, seniors could face further health deterioration, the though of ineligible individuals taking advantage of the services provided by these day centers leads some Medicaid officials to believe they are “gaming the system.”

Advocates for the elderly have been complaining that these “pop-up” centers have been siphoning clients from regular senior centers, often times with bribes, and referring them to managed care plans that eagerly enrolled them.

One senior told the New York Times that a certain center offers kickbacks that could be $5 one day, a $10 grocery coupon or an unlimited MetroCard on another day to get them to join.

These new social centers can afford to pay higher rent than other senior centers run by the city, the article notes.

“They are draining well-elderly out of the regular centers in every part of the city where they exist,” said Joan Pastore, director of AMICO, a center in Borough Park, Brooklyn. “How many frail old ladies do you know who play Ping-Pong, do computer and go dancing?”

Read the New York Times article.

Written by Jason Oliva

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