State Officials Have Run Up An Expensive Tab With Medicaid

Gov. Andrew Cuomo was full of baloney last week when he laid the blame for the state’s $4 billion Medicaid deficit at the feet of counties.

The governor may have sprained a shoulder muscle patting himself on the back for the state’s decision to cap counties’ share of Medicaid spending, a decision the governor says is a large part of the reason New York has a deficit in the program. He also lays blame at the feet of county Social Services departments for improper administration of Medicaid programs that Cuomo says lead to higher costs in the program.

Capping the local share of Medicaid was a necessary decision back in 2013 — no county could have lived within the state’s 2% tax cap without capping local spending on Medicaid. The state’s decision to cap local Medicaid spending was one of the most important actions the state has ever taken to remove an unfunded mandate from local governments, and even then one could argue that New York should handle Medicaid like 24 states that pay the entire Medicaid cost with no local county share.

Besides, counties have no say in what the state program covers. There are many reasons why New York’s Medicaid program is the second-costliest program in the country behind only California, but the biggest reason is that New York’s program covers more than other states have chosen to cover. State legislators continue trying to add to the list of things New York’s Medicaid program should cover. And, we shouldn’t forget that in the heyday of the Affordable Care Act, Cuomo and state legislators jumped at the chance to expand New York’s already expensive Medicaid program by accepting federal funding under the Affordable Care Act so that Medicaid could cover low-income, non-elderly adults. The expansion added about 800,000 to the Medicaid rolls in New York state. Expanding Medicaid was popular under President Barack Obama. It may not prove to be such a great decision under the tenure of President Donald Trump in the face of federal program cuts.

We also don’t buy the governor’s arguments about improper administration in the Medicaid system. Surely there are people who try to scam the system, but Chautauqua County used to have a Medicaid czar whose job was to root out fraud and abuse. There simply wasn’t that much abuse locally to warrant having the position.

The local cap on Medicaid spending should under no circumstances be repealed. It was New York state officials who have chosen, over the years, to add programs and coverage to Medicaid without consulting with counties. It was New York state officials who chose to jump at President Obama’s federal aid to expand Medicaid under the Affordable Care Act. And New York state officials chose to implement a 2% property tax cap while adding mandates such as criminal justice reform to counties.

Decisions by New York state officials have run up quite the expensive Medicaid tab. New York state officials should find a way to pay that bill.