Department of Health

Monitoring Home Care for Medicaid Recipients

Home care services are medical services and related social support services that are provided to patients in the patients' homes by qualified service providers. In New York's Medicaid program, home care services are generally provided through community-based agencies that are regulated by the Department of Health and the 58 local districts overseen by the Department. During 1997, home care services were provided to about 109,000 Medicaid recipients at a cost of about $694 million to the Medicaid program.

According to State law, if a Medicaid recipient is expected to receive home care services for more than 60 days, the expected cost of the services should be reviewed by the local district to ensure it does not exceed certain guidelines. However, we found that this review often was not performed in the ten local districts we reviewed. We also determined that, in 1997, home care services may have been provided to as many as 5,200 Medicaid recipients who were not eligible for the services, because the cost of their services exceeded the guidelines. As a result of these services, New York's Medicaid program may have incurred as much as $102 million in excess costs. We also determined that improvements are needed if all home care providers are to be inspected and if all patient complaints are to be investigated in a timely manner.

For a complete copy of Report 98-S-28 click here.
For a copy of the 90-day response click here.