2011 Medicaid Rankings

United Cerebral Palsy (UCP), an organization that educates, advocates, and provides support services for individuals with various disabilities, recently released its 2011 Medicaid rankings for the 50 states in the U.S. and the District of Columbia.  The report estimates that Medicaid spending amounted to $37.3 billion in 2009 for the 635,000 individuals with intellectual and developmental disabilities that it served.  New York's position in these rankings may be of particular interest to some people in light of the numerous difficulties that individuals in New York have encountered recently when it comes to finding appropriate housing and services.  Group home closures, longer waiting lists, and budget cuts are partially responsible for NY's recent problems.  A closer look at the UCP's findings may shed light on the root of some of these problems and how we match up to other states. 

These rankings were developed through a process of collecting data that involved assembling statistics from all 50 states and D.C.; reviewing information from numerous governmental non-profit and advocacy organizations; and consulting with Medicaid and disability experts around the country.   A weighted grid was used to assign points to each state based on its performance in a number of categories such as promoting independence, tracking quality and safety, keeping families together, promoting productivity, and reaching those in need.  These categories were further broken down into specific measurable criteria - i.e. subcategories (such as % receiving home and community based services; % living in resident settings with 1-3 people; family support services; etc.  The study is based on data from 2009, the most recent available, and focuses not on all individuals with disabilities but only those with intellectual or developmental disabilities.  It emphasized the importance of including these individuals within the community (not in isolated setttings such as large state institutions) and assigned the highest weight to those criteria that it felt were most closely related to inclusion. 

Overall New York was ranked #17 which by itself doesn't say a ton.  In terms of allocating resources to those in the community, New York was ranked #43.  In terms of supporting individuals in the community and home-like settings, New York ranked #36.  For keeping families together through familiy support, New York ranked high at #10.  In terms of supporting meaningful work, New York ranked at number #36.
New York is one of only 9 states that report more than 2,000 residents living in large public or private institutions.  New York is not on the list of states who have at least 95% of individuals served living in home-like settings (meaning, at home, in their family's home, or in setting with three or fewer residents).  New York is not on the list of states who reduced the number of Americans living in large institutions by 20% or more from 2005 to 2009. 

Other noteworthy points:

- New York is among the top few states when it comes to the number of residents in "congregate care" living situations of 1-3 people and it is also among the top states when it comes to the number of residents in congregate care living situations of 16+ people.  This suggests to me that while it offers a lot of people smaller living arragements, improvement is needed with respect to those in larger homes. 

- New York has a high number of large state facilities.  Only Texas has more.

- New York is in the top 10 when it comes to overall spending for family support services - $56 million - but almost every state spends more money per family.  This has to do with the sheer number of NY families who need family support services - a total of 41,571 families (highest in the country with the exception of California which has roughly 81,000 such families). 

- New York has a waiting list of roughly 4,400 people for residential services.  Only 5 states have longer wait lists. 

- If you look at total expenditures, New York is the highest of all states.  If we're spending so much money, why aren't we seeing better results?

I am not an expert in interpreting these data and my review of these figures is cursory at best.  But I think a thorough understanding of what is going on here is important and that includes understanding why certain states consistently lead or trail.  The study suggests that the size of a state's population or the affluence of its constituents is not the reason.  California is a large state, Vermont is a small state, and both are leaders.  Massachusetts is considered a wealthy state while Arizona is considered less affluent - both are leaders.  According to UCP, Arizona and Vermont have consistently been ranked at #'s 1 and 2 since 2007.  I think it would be useful to understand why this is the case and bring some of those tricks to New York.