COMPTROLLER'S AUDIT FINDS NASSAU SPENDS MILLIONS MORE
ON PERSONAL CARE SERVICES THAN COMPARABLE COUNTIES

Nassau County's Medicaid personal care services program spends more than twice as much as programs in comparable counties, and has much higher costs per recipient, according to an audit of the $87-million program issued today by Nassau County Comptroller Howard S. Weitzman.

The Comptroller cited inefficiencies and wasteful practices in the administration of the Personal Care Services program, mandated by Medicaid and administered by the county's Department of Social Services (DSS), which provides home health care services such as housekeeping, meal preparation, bathing, toileting and grooming to Medicaid clients. In addition, the audit report, covering the years 2002-2003, says the New York State Health Department imposed penalties of over $2.4 million on Nassau for failing to meet its efficiency targets for the periods July 2002-March 2003, and July 2001-March 2002. The state requires the county to control costs because it pays approximately 40 percent of the program's cost. (Of the remainder, the county pays approximately 10 percent and the remaining 50 percent comes from the federal government.)

"Nassau County's annual cost of providing home health care to Medicaid recipients is considerably higher than other comparable counties in New York State," Mr. Weitzman said. "No one disputes that providing personal care services to those eligible for Medicaid is an important safety-net program. But for such programs to be effective, they must be run efficiently in order to maximize our resources.

"Nassau's cost is the highest, both for the personal care services it provides and for services that are arranged by the consumer under a sub-program that allows clients to recruit their own personal assistants. For instance, in 2002 Nassau's total cost of both programs was approximately $87 million. In the same year, Suffolk's cost was about $23 million, a difference of $64 million (see chart).

"As for the $2.4 million in state penalties, DSS has indicated that it believes the state's guidelines are unrealistic. If that's the case, we would encourage them to lobby for change in Albany; but, in the meantime, the agency must do all it can to meet those guidelines and avoid costly penalties."

Although Nassau ranked fifth in total Medicaid-eligible population among counties other than NYC in 2002, far more of the Medicaid-eligible population in Nassau received personal care services than did Medicaid-eligible in the other counties, a fact that cannot be explained solely based on demographic differences. Of the five counties outside New York City with the highest Medicaid-eligible population (Nassau, Suffolk, Westchester, Erie and Monroe), Nassau's rate of 4.9 percent of Medicaid clients receiving personal care (3,675 recipients in 2002) is more than three times the average rate of the other counties.

In its response to the audit findings, DSS maintains that personal care in the home is an effective alternative because it reduces dependence on costly nursing homes, and notes that Suffolk County spends more on nursing homes than Nassau.

"Reducing the need for nursing home care is a laudable goal," Mr. Weitzman said. "But when you look at the whole picture, Nassau's combined costs of home care and nursing home care for those eligible for Medicaid are still $13 million a year higher than Suffolk's. This is true even though Suffolk in 2002 had 13 percent more Medicaid enrollees likely to use long-term care services (those classified as aged or blind and disabled) than Nassau County. The total percentage of such individuals receiving one form of care or the other is 31.4 percent in Nassau, versus 25.9 percent in Suffolk. The bottom line is that Nassau's greater use of personal care in the home is not resulting in overall lower costs of taxpayer-subsidized long-term health care for this population."

Among the report's other findings:

• Nassau currently provides almost double the number of weekly hours of care per client (51 hours) as do Suffolk (26) and Erie (22) Counties, and over 40 percent more than does Westchester (35).
  
• A report the county commissioned from an independent research organization concluded that "if DSS could reduce the average hours per patient, per week, to the mid 20's, as has been done in Westchester, Suffolk, and Erie counties, annual savings would approach $45 million, with a county share of $4.5 million."
  
• DSS uses nurses hired under contract from the Nassau Health Care Corporation to perform case management, social assessments and clerical functions for the home care program. In some cases these functions can be performed by caseworkers and clerical staff, at lower cost.
  
• Home care services are being provided in violation of state regulations that require doctors' orders for home care to be dated within 30 days of physical examinations. As a result, 28 percent of forms accepted during the audit period were found to be out of date or undated;
  
• DSS uses an antiquated Wang computer system and inefficient manual records to run the program. The absence of a computer link between the DSS system and the state's welfare management system could result in clients receiving services despite ineligibility or after their cases have been closed.

The complete audit report may be viewed by clicking on the link below.

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Nassau County Department of Social Services:
Personal Care Services Program for Medicaid Recipients ( ~ 379 kB - 50 pages pdf file )