Expanding Health Care Coverage

Grantee Name

The Nelson A. Rockefeller Institute of Government, The State University of New York

Funding Area

Expanding Health Care Coverage

Publication Date

April 2011

Grant Amount


Grant Date:

September 1, 2007–May 31, 2008


Medicaid is the single largest funding source for long-term care, paying for half of all nursing home and community based long-term care in the nation.

Given the disproportionate use of Medicaid as a funding source for long-term care, the New York State Department of Health’s Office of Health Insurance Programs was looking for potential policy improvements to better target Medicaid spending and services. In addition, many states are looking for ways to reduce asset transfers as a means for reducing long-term care costs. Under this grant, New York State Health Policy Research Center at the Rockefeller Institute of Government (Rockefeller) undertook two studies. The first study compared New York State to other states on a range of long-term care issues. The second study reviewed the prevalence of denials for Medicaid-funded nursing home care and found wide variation in reported denial rates across the State’s counties. Both reports resulted in widespread press coverage across the State.

This project was part of a larger NYHealth authorization that funded a series of quick-strike analyses to help the New York State Department of Health’s (NYSDOH’s) Office of Health Insurance Programs find ways to streamline and expand its public health insurance programs.

Read an NYHealth special report that contains a summary of findings from this authorization.

Read Medicaid and Long-Term Care: New York Compared to 18 Other States, a Rockefeller-produced report about how New York compares with other states on a range of long-term care issues, such as demographics, spending, and quality.

Read Assessing Asset Transfer for Medicaid Eligibility in New York State, a Rockefeller-produced report about the incidence of asset transfers for Medicaid-funded long-term care.

Read additional analyses NYHealth funded Rockefeller to conduct based on its findings on rates of asset transfers.

One important lesson emerged from this project regarding data extractions. Although the data necessary for this project were collected for administrative purposes, they were difficult to use for research. One way to address this shortcoming is to fund upfront work to see if the desired analysis is possible and whether the limitations present too much of a barrier to make a larger study worthwhile. Read about how this issue has come up on another NYHealth grant to date.

Outcomes and Lessons Learned

  • Assisted NYHealth in selecting priority research areas and identifying grantees to fill these research needs of: collapsing Medicaid eligibility categories; simplifying the eligibility process for the Medicaid Excess Income program; identifying possible reforms for the State’s reimbursement policies for various health care services; and understanding the prevalence of asset transfers occurring under the Medicaid-funded nursing home care program.
  • Developed a comparative database and descriptive report on how New York State compares with other states on a range of long-term care issues.
  • Produced a report on the prevalence of asset transfers within the Medicaid -funded long-term care program.
  • Examined the operations, strengths, shortcomings, and research priorities of other health policy centers in the United States to determine how a state health policy research organization might be structured in New York.