Home And Not Alone

What do you think is the most common occupation in New York?

Retail worker?

Restaurant worker?

Government employee?

It might surprise you that the top occupation in New York is home health and personal care aide.

Source: Grok

Over twice as many New Yorkers are employed as home health aides as the next highest occupation----Retail Salespersons.

Almost 600,000 people are employed as home health aides in New York.

That is equal to 6% of the entire workforce.

Who pays the bill for most home health aides in New York?

Medicaid. 

In other words---the taxpayer.

New York spends over $115 billion per year on Medicaid.

On a per resident basis, New York spends 24% more than any other state in the nation and 77% more than the national average.

Source: https://www.empirecenter.org/publications/new-yorks-medicaid-spending-rate-remains-the-highest-of-any-state/

To understand how large the amount of Medicaid spending is in New York, compare it with Florida.

Florida has a larger population than New York (estimated 24 million in FL vs. 20 million in NY at the end of 2025) but Florida is only spending $35 billion on Medicaid.

Florida is spending 70% less for Medicaid services even though its population is 20% higher!

This is despite the fact that Florida has an older population (42.7 median age) compared to New York (39.4). That should result in a higher number of those who are disabled or who are in need of long-term care and do not have the money to pay for it.

How can the Medicaid costs be so much higher in New York than the rest of the country?

Part of it is the cost structure and cost of living in New York. Health services cost more in New York than many other locations in the United States.

A second reason is that New York elected to broaden the eligibility for Medicaid for residents making up to 250% of the federal poverty level. Only two other states do this---Oregon and Minnesota (wouldn't you know?).

Consider the Medicaid enrollment numbers in New York City in 2024.

Almost half of the city is on Medicaid receiving free health care. That number is almost 2/3 in the Bronx.

Credit: https://x.com/vjeannek/status/2005292438576132304

Add to that one more reason why New York's top occupation has become home health and personal care aides.

New York Medicaid allows family members to be paid for providing home health services.

That allows eligible recipients to choose, hire, and direct their own caregivers, including most family members and friends.

There is very little vetting of the caregiver beyond filling out a form and the Medicaid payments begin.

Here are the key points about that program as summarized by Grok.

Source: Grok

In theory, this is a good idea.

It is much more cost effective to care for a disabled or elderly person in a home setting rather than in a nursing home of other institutional setting.

However, it is an open invitation for fraud.

There is the potential for fraud on two levels that can play out in this situation

You first get someone qualified with some type of disability that provides them with disability income and Medicaid benefits.

You then get a family member or two to be put on the Medicaid rolls as a home health aide to take care of them. For round the clock care you might need three of four family members to be on the Medicard payroll.

The entire family lives off of the Medicaid fraud.

This woman outlines what is going on in New York.

The Medicaid fraud in Minnesota (much of it involved in home health care) is undoubtedly small compared to what is going on in New York just looking at the dollars in play.

You may recall that Kamala Harris wanted to extend home health services for those on Medicare and not limit it to Medicaid.

Here is what a health policy expert said about home health care and Kamala's proposal back in October, 2024 in an article in Forbes magazine.

Can you imagine what that would have cost and the potential fraud and abuse that would have been possible if it also applied to Medicare?

New York is not the only state in which home health care and personal care is the leading occupation. 

10 states also have that same distinction.

Is it a coincidence that 8 of these 10 states voted for Kamala Harris in the 2024 election?

West Virginia and Pennsylvania were the exceptions.

The populous states above with the huge number of home health aides has contributed to making home health and personal care aides the leading occupation (by numbers) in the United States!

Source: Grok

What kind of country have we become when home health aide is the leading occupation in the United States?

At various time over the last 100 years it was farming, manufacturing worker, clerical worker, technical worker or sales person.

What kind of political leaders would permit the level of fraud that is undoubtedly going on with Medicaid and home health?

It is just one more example of how the best of intentions becomes subverted by fraud, waste and abuse in government programs.

When you have an open checkbook and almost no one with a vested interest in oversight, you can be assured that fraud, waste and abuse will follow.

It appears that the innovation pictured below can't come soon enough.

Source: https://www.azorobotics.com/News.aspx?newsID=15579

Help, Elon, Help!