Albany, We Have a Problem

Here in Rockland, every year, more than the equivalent 51% of our Property Tax Levy, $66.7 million to be exact, goes to funding Medicaid. On the State level rising Medicaid costs are driving a $6.1 billion budget gap. Governor Cuomo believes that counties, like Rockland, are responsible for running up the tab and has suggested we shoulder more of the costs.

This column may not be long enough to detail all the things wrong with his recent statements on Medicaid. At best the Governor is misinformed, at worst he is being extremely disingenuous. New York State already forces counties to pay more for Medicaid than any other state in the nation; a program over which we have very little local control. In reality, New York State offers one of the most extensive and rich programs in the nation, going well beyond the Federal benefit levels.

We do not control eligibility guidelines or benefit levels and have next to no access to the information we need to root out fraud. Forcing counties to pay for something we have no control over is not just unfair but quite clearly dysfunctional. Typical of Albany.

The state has taken over the processing and eligibility determination for approximately 80% of Medicaid cases. In years past we were able to use front end detection to identify fraud or misuse at the time of application, before tax dollars were spent on benefits. Department of Social Services Investigators looked for indicators that had been approved by the state as red flags, including expenses that exceed reported income, applicants who worked off the books or people who were self-employed but didn’t have records to substantiate reported information. Now, because of the way Medicaid expansion under the Affordable Care Act was implemented, it is up to the State to perform these types of investigations of which the county has no control of.

If the State of New York is running Medicaid, then let the State of New York pay the bill. The Governor’s current plan to shift more costs to counties could create an additional $1.5 – $9 million in estimated local costs annually. This is unacceptable, especially after facing $4.5 million in new state mandate and program costs for 2020. What the Governor is suggesting could have a significant negative financial impact on not just Rockland but the other 61 counties of New York as well.

It is well past time that New York State develop a real plan to find efficiencies, root out fraud in the Medicaid program and get to work eliminating the mandated local share. I am calling for a top to bottom examination of this program that asks the difficult questions and then determines a way to make this program sustainable.

We must ensure that benefits are available for those who truly need them as a last resort. Let’s stop the delays and finger pointing over who is to blame and find a way to make this program fair to the taxpayers of the Empire State.