NUMC's financial struggles: Hospital has highest percentage of Medicaid or Medicare patients on Long Island

Until his retirement last year, Jerry Laricchiuta spent nearly two decades as a union leader representing Nassau University Medical Center employees. He’s also seen the East Meadow hospital from another side: the one patients experience.

Laricchiuta’s three daughters have all received mental health and substance use disorder care at the hospital, the Massapequa Park resident said in an interview — care that sometimes required days-long stays at the facility. 

Why NUMC? All three, once they turned 26, were no longer able to stay on their father’s health plan. Unable to work sometimes for extended periods, they went without insurance or enrolled in Medicaid, a public insurance program for low-income people. And many Long Island psychiatrists don’t accept patients on Medicaid, Laricchiuta said, much less patients with no insurance.

"You can call up 10 in a row," he said. “‘You take Medicaid?’ ‘No, I'm sorry.’ Click. And that's frantic for a family, because the family is the one that's trying to get help for this person that needs direct therapy, needs direct medication, needs to be hospitalized sometimes."

The family’s experience highlights what health care administrators and experts say is a longstanding concern on Long Island and beyond: Patients with public insurance often struggle to find practitioners who will take their insurance, leaving them with fewer options than their privately insured counterparts.

That leaves public safety-net hospitals like NUMC with a disproportionate share of publicly insured patients.

NUMC served a greater percentage of patients on Medicaid in 2024 than any other hospital on Long Island, state data show. And it served a greater combined percentage of patients on public insurance — Medicaid and Medicare combined — than any other hospital in Nassau and Suffolk counties.

By and large, hospitals lose money treating patients insured with public insurers. That’s one of the central challenges NUMC faces as it works to find more stable financial footing.

In November, Newsday reported the public hospital has lost millions on a near-annual basis for a quarter century, and has one of the worst financial positions of any New York State hospital. As it works to stabilize its finances, the facility last month named Thomas W. Stokes as its new chief executive and president. He will start in January.

This is the second in a series of stories that will examine the hospital's finances and operations, diagnose the root causes of its dysfunction, and outline potential solutions to what has become one of Nassau County’s most intractable dilemmas.

"We take all comers for everything," Richard Becker, the hospital’s interim CEO, said in an interview this fall. "So that puts us in a challenging position to begin with."

Paying for medical care

Broadly speaking, patients generally have one of three types of insurance: Medicaid, Medicare and private insurance.

Hospitals generally make money by treating patients with private insurance: Blue Cross Blue Shield, Cigna, UnitedHealthcare, etc. Those insurers reimburse hospitals and clinics varying amounts, but generally pay enough to cover the cost of care and then some, health care administrators say.

Meanwhile, patients insured through public insurance programs, Medicare and Medicaid, generally bring in significantly less reimbursement money.

Medicare is a federally funded insurance program geared mostly for people 65 or older.

Medicaid is a program funded jointly by the federal government and state governments for low-income patients.

New York determines who is eligible for Medicaid by checking an applicant’s income. Eligibility is determined based on the federal poverty level.

In New York, residents whose income is up to 138% of the federal poverty level — up to $44,367 a year for a household of four — are eligible for Medicaid. (The income limits for pregnant women, infants, children and young adults are more generous.)

Both Medicare and Medicaid programs do not cover the cost of providing the care they pay for, health care administrators say, although Medicaid is particularly unprofitable.

"We’ve estimated that Medicaid pays just 70 cents for each dollar of care provided by New York’s hospitals; Medicare pays 89 cents," Janae Quackenbush, a spokeswoman for the Healthcare Association of New York State, said in an email.

A challenging patient population

To examine NUMC’s patient population, Newsday analyzed state hospital discharge data from 2024. The data show characteristics for all patients who were admitted to hospitals for any reason and then discharged.

According to that data, 57% of all patients discharged from NUMC paid primarily with Medicaid — the highest percentage of any hospital in Nassau or Suffolk.

Stony Brook Eastern Long Island Hospital, a 70-bed hospital that treats a large number of substance use disorder and psychiatric patients, saw the second-highest percentage of Medicaid patients, around 54%.

NUMC accounted for just 6% of Nassau County’s patient discharges, but 16% of the county’s Medicaid discharges last year.

NUMC serves a disproportionate number of people in poverty.

About 22% of Nassau County residents are enrolled in Medicaid, and about 21% in Medicare, according to state and federal data. Suffolk County is roughly the same: 24% Medicaid, 21% Medicare. (It is possible to be enrolled in both programs.)

Hospitals see very different mixes of patients on Long Island — even if they are close together.

At NUMC, only about 10% of discharged patients paid with private health insurance, according to the 2024 data.

In Mineola, meanwhile, at NYU Langone Hospital — Long Island, about 5 miles west of NUMC, roughly 36% of the patients discharged paid with private insurance.

A spokesperson for NYU Langone acknowledged a request for an interview and comment but did not provide either.  

Location and personal preference

Why the disparities? Part of it depends on what kind of services a hospital offers.

NUMC has roughly 150 inpatient psychiatric beds and treats thousands of psychiatric patients, who are disproportionately insured with Medicaid, each year.

Part of it is geography. NUMC is just a short trip from communities with poverty rates that are higher than the county as a whole.

The county itself has a poverty rate of 5.3%, according to U.S. Census Bureau data. Hempstead Village, meanwhile, has a poverty rate of 14.8%, Uniondale 10.5% and East Meadow 6.9%.

What’s more, NUMC is centrally located in the densely populated county, meaning it draws emergency patients from all over, according to David Kaldor, chair of the Nassau Regional EMS Council.

Patients experiencing certain time-sensitive emergencies — stroke, heart attacks or trauma — are taken to the nearest hospital equipped to treat those conditions, Kaldor said.

But patients with less urgent conditions can express a preference for or against hospitals: "Patients can say, ‘I want to go to XYZ hospital, because my doctor is there,’ " Kaldor said. Most ambulances will honor those requests, he said.

Patient choice plays a significant role, hospital leaders say. Uninsured or Medicaid patients likely feel comfortable going to NUMC, where they will be welcomed, administrators there said in an interview.

But the inverse is true as well, Becker, the interim CEO, said.

"The phenomenon that happens is self-selection, right?" he said. Patients with private insurance "are less likely, in general, to choose to go to a public hospital. They’re just not going to do it."

‘A tiering system’

One of the bedrock principles of U.S. health care is hospitals cannot turn away patients in need of medical care. That means patients who are uninsured or on Medicaid cannot be denied entry into any hospital.

New York hospitals must provide all "care that's immediately necessary" to any patient, said Wendy Darwell, president and CEO of the Suburban Hospital Alliance of New York State and the Nassau-Suffolk Hospital Council.

But when it comes to non-emergency care, the reality is more complicated, some say.

Newsday interviewed administrators at three networks of federally qualified health centers — a type of primary care facility that receives public funds, accepts all patients and charges on a sliding scale — that operate in Nassau and Suffolk counties.

These facilities see a patient population that is heavily insured with Medicaid, but generally don’t offer inpatient or specialty care.

Leaders at all three networks said it is very difficult to find specialists who will accept their Medicaid patients.

"The evidence, not my opinion, the evidence will demonstrate that there is a tiering system, where there's a differentiation of access for Medicare, for commercial and Medicaid," James Sinkoff, chief financial officer of Sun River Health, a statewide network of nonprofit health centers, said in an interview.

The primary care centers rely heavily on local safety-net hospitals: NUMC in Nassau County and Stony Brook University Hospital in Suffolk County, he said.

"It's very difficult for us to work with other hospital systems outside of NUMC to take care of our patients," David Nemiroff, president and CEO of Harmony Healthcare, a chain of six primary care clinics and four school-based centers in Nassau, said in an interview. "And that's just the way it is here in Nassau County."

Newsday reached out to all the other health networks that operate hospitals in Nassau. A spokesperson for Catholic Health declined to comment, and a spokesperson for NYU Langone acknowledged a request for comment but ultimately did not provide one.  

Other local health care networks said they have no barriers to serving Medicaid patients at their facilities.

"Mount Sinai South Nassau serves a primary catchment area with more than 900,000 residents and provides them with the health care services they need, regardless of their type of health insurance coverage," Damian Becker, a spokesperson for Mount Sinai South Nassau, said in a statement.

Jeffrey Kraut, an executive vice president at Northwell, said in an interview the Long Island-based health care system is committed to serving its communities, regardless of insurance status.

Every one of Northwell’s locations takes Medicaid patients, and the network has some of the most generous financial assistance policies in the state for uninsured and underinsured patients, Kraut said, pointing to an agreement between the system and the New York attorney general.

"Our mission is to improve the health of patients and the communities we serve," Kraut said. "That's what everybody who works for us understands. That's why we're here."

‘Catches the people falling’

NUMC’s existence is, in a way, a benefit to neighboring hospitals. The hospital accepts a high volume of emergency patients and psychiatric patients, like Laricchiuta’s family.

That’s a population of patients — many insured with Medicaid — that other hospitals just don't have the infrastructure to treat, according to Darwell, of the Suburban Hospital Alliance.

"It's no easy thing to just build a bigger emergency room or build entirely new inpatient units," Darwell said.  

Some administrators and experts interviewed by Newsday see it differently: NUMC treats patients other hospitals simply don’t want.

Other hospitals "understand that we treat patients they would rather us treat," Stu Rabinowitz, chair of the hospital's board of trustees, said in an interview.

But a hospital that loses money on treating 85% of its patient population is extremely difficult to operate sustainably.

"You have a prescription for what is, all things equal, going to be a very financially challenged institution," Art Gianelli, who ran the hospital from 2006 to 2014 and is currently an executive at One Brooklyn Health, said in an interview with Newsday earlier this year.

And yet that "challenged institution" is critical for the patients who need it — many of whom, like the family of Laricchiuta, may be unable to find care anywhere else.

"It's a safety net," Laricchiuta said of NUMC. "It catches the people falling, you know, all the way down the many, many flights of having no insurance, and being frantic, desperately in need of medical care and not being able to get it."