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statutory requirement for residential and home care services being under the same legal entity could jeopardize future federal financial participation for Medicaid services in these facilities.

Limited Licensed Home Care Services Agency Evaluation

The 1997 legislation requires that a report be submitted that describes any cost savings associated with the LLHCSA program, focusing particularly on the following areas:

  • The total number of hours and individuals served by LLHCSA

  • The kinds of services provided by LLHCSAs

  • The number of patients diverted from higher cost care settings and the estimated average savings per resident diverted.

  • Whether the provision of service provided through LLHCSA generated a cost savings

  • Whether the expenditures, the number of hours and the number of recipients receiving personal care services in adult homes and enriched housing changed compared to the prior two years before implementation this section.

Methodology and Results

Medicaid claims data were reviewed for individuals making LLHCSA claims through November 2004. For each individual making a LLHCSA claim, all claims were reviewed for the period after the individual became a LLHCSA recipient. As of November 2004, there were 32 limited licensed facilities across the state. By the end of November 2004 only 14 of the 32 facilities reported expenditures and all but one of these programs was upstate (the single downstate program reporting expenditures was in Nassau county). Between 1999 and the current period, only 183 individuals received limited home care services for which Medicaid was billed.

The LLHCSA claims available for these analyses began in 1999 and extended through November 2004. Any individual making any LLHCSA claim during the period was included in these analyses. Table 2 includes selected expenditures for all LLHCSA recipients after they made their first LLHCSA claim. The table displays the total Medicaid dollars, the average dollars per LLHCSA recipient spent during the period, and the total and average service units (days/hours/claims) per LLHCSA recipient for both in- home and institutional categories of services.


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