Governor Wants Counties to Pay More for Medicaid

Odell: Proposal could ‘devastate our budget’

The county executives in Dutchess and Putnam have each expressed their opposition to a proposal by Gov. Andrew Cuomo to shift at least $150 million in Medicaid costs to local governments to help close a $6.1 billion state deficit.

New York is one of the few states that require county governments to contribute to the cost of the federal program, which in New York provides health insurance for 6.2 million low-income families and individuals. New York is also one of the states that expanded Medicaid eligibility under the 2010 Affordable Care Act, reducing the number of uninsured but increasing costs.

“Here in Putnam we take care of our most vulnerable citizens, and will always make sure they get the services they need,” County Executive MaryEllen Odell said in statement. But if the state asks counties to pay more, “we will have to make other cuts that will devastate our budget.”

Officials across the state have for decades petitioned state lawmakers to relieve them of their contributions to the program, which in Putnam last year amounted to $9.6 million, and in Dutchess, $41.3 million.

In Putnam, where Medicaid is the county’s largest single expenditure, costs rose by $4 million between 2018 and last year, county officials said. The county has 13,114 residents enrolled in Medicaid, up from 5,000 in 2015 before the expansion under the ACA.

To stay below the 2 percent property tax cap, Putnam can increase its budget by $1.2 million this fiscal year, county officials said. Under Cuomo’s plan, Medicaid costs would increase anywhere from $194,650 to $1.75 million, according to an estimate from the New York State Association of Counties.

In Dutchess, where 57,190 residents are enrolled in Medicaid, its share could rise $3 million to $5 million under the proposal, said County Executive Marc Molinaro.

To assist counties, state lawmakers in 2012 agreed to pay for any growth in the program and cap the annual county share at $7.6 billion. New York State estimates its costs during the 2020-21 fiscal year will be $23.6 billion, with the federal government contributing $39.9 billion.

But under Cuomo’s proposal, the state would no longer cover the growth in Medicaid costs for counties that fail to stay within the 2 percent tax cap or whose Medicaid costs grow by more than 3 percent.

New York would also cap the counties’ share of a federal program that provides financial assistance to localities that face higher costs from the expanded Medicaid eligibility under the Affordable Care Act.

When counties were paying the costs without a cap, they had incentive to keep costs low, Cuomo said in January during his budget presentation. But now, “they pay the same amount every year. Their cost does not go up. It doesn’t matter what they spend.”

Molinaro has a different take. “This is a drastic reversal of an agreement counties have lived up to for years,” he said.

Under Cuomo’s proposal, according to projections by the state comptroller, counties would see their share of Medicaid spending fall to $7.2 billion from $7.33 billion, followed by an increase in 2021-22 to $7.354 billion.

In 2010, under Cuomo’s direction, the state convened a Medicaid Redesign Team to find savings in the face of a $10 billion overall deficit. The MRT has been reconvened, this time to find $2.5 billion in savings as the state races to finalize a spending plan before April 1.

Officials from Dutchess and Putnam say they have little control over the number of people who enroll in Medicaid because the eligibility criteria is set by the state and most enrollees are approved through its health exchange. Molinaro said Dutchess County only determines eligibility in 30 percent of cases.

“The assertion by the governor that local governments are to blame for growing costs is patently false,” Molinaro wrote in a letter to state Assemblyman Didi Barrett, whose district includes part of Dutchess. In a statement, state Sen. Sue Serino, a Republican whose district includes the Highlands, called Cuomo’s proposal a “gimmick being used to try and balance a bloated state budget.”

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