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Counties want state takeover of Medicaid costs

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Counties across New York state are supporting legislation that would phase out the local share of Medicaid payments, but officials doubt the bills will ever become law.

Medicaid, a state program for New Yorkers who can't afford medical care, is among the biggest strains on county budgets, especially as lawmakers struggle to present budgets that meet the state's new 2 percent cap on property tax growth.

The Senate and Assembly introduced bills earlier this fall that would shift Medicaid costs from the county level to the state. Chris Morris reports.

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Chris Morris
Tri-Lakes Correspondent

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Stephen Acquario is executive director of the New York State Association of Counties. He says Medicaid is by far the largest unfunded mandate placed on counties.

Statewide, the program costs some $7.2 billion. About $2.1 billion of that is funded by property taxes outside of New York City. Another $5 billion comes from taxpayers in the City.

Acquario says two separate bills in the Senate and the Assembly would have the state pick up the local share of Medicaid. He says the legislation proposes a gradual, eight-year phase-out of county Medicaid payments.

“I think for the first time in a long time, we have the Republican-controlled Senate responding to the needs of local government in a very thoughtful and deliberative way,” Acquario said.

Acquario says the legislation would be paid for with state savings and new federal funds. He says that contrary to what opponents of the legislation say, the bill does not represent a cost-shift to the state.

“Last we knew, county (and) local taxpayers subsidize the state’s program, not the other way around,” Acquario said, “and for anybody to say otherwise is being disingenuous with the public.”

Acquario says nearly every state senator from upstate New York has sponsored the bill. He says he’s surprised that Senator Betty Little, who represents a broad North Country district, has not signed on.

“We need Senator Little’s leadership, power and influence,” Acquario said. “Of the state Senate, she has six counties, one of the largest senate districts in the state and one of the most rural areas in the state. We need her leadership and passion and understanding for local government and put that to use to help us.”

Little says she understands the burden Medicaid puts on counties. She adds that the state now allows only 3 percent annual growth in the program’s cost before the state takes over payments.

According to Little, the phase-in bill doesn’t have a revenue source. And she says New York City would be the biggest benefactor of the legislation.

“The legislation certainly has pointed out the difficulty that the counties are having and that the tax cap is making them all have to look at where there is growth and how they can control their spending,” Little said. “It certainly has given us more of an emphasis and push for mandate relief.”

Acquario says unfunded mandates jeopardize a county’s ability to offer popular services to local taxpayers. Both Essex and Franklin counties will lay off workers in order to meet the tax cap next year, and in Essex County, lawmakers have discussed discontinuing popular services like the Horace Nye Nursing Home and the fish hatchery.

In Essex County alone, some $7 million goes toward Medicaid payments – that’s nearly 50 percent of the total tax levy.

Essex County Manager Dan Palmer says shifting those costs to the state would be welcome news, although he’s skeptical the bills will move forward.

“I don’t know how a state that’s three billion in the hole right now is going to takeover the payment of that,” Palmer said. “Maybe they will. It would be great if they did, but let’s put it this way: I’m skeptical. I’d love to see it, but (I’m) very skeptical.”

Essex County recently passed a resolution urging the Legislature to implement a multi-year state takeover of Medicaid. Acquario says counties across the state have taken similar action.

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