DataPoint: Payor Mix

Based on a LeadingAge NY analysis of Residential Health Care Facility (RHCF) Cost Reports received from the Department of Health (DOH), private pay funding represented 14.5 percent of nursing home revenue statewide, a 1.3 percent increase over 2015. Private pay revenue as a proportion of total revenue increased in five of seven New York State regions, decreasing only in the Rochester and Buffalo regions. During 2016, Medicaid Managed Care increased to 4.5 percent of nursing home revenue, up from 1.8 percent in 2015. Medicaid Fee for Service (FFS) fell to 51.6 percent of all nursing home revenue, a decrease directly correlated with the increase in the proportion of Medicaid Managed Care revenue. The New York City region relied on Medicaid FFS funding most (56.1 percent), while the Long Island region utilized Medicaid FFS least (43.7 percent).

Further regional breakouts of 2015 and 2016 payor mix based on revenue are available here and here.

Contact: Ken Allison, kallison@leadingageny.org, 518-867-8820