Counties have little control over Medicaid costs, region’s officials say

PLATTSBURGH — The Medicaid Redesign Team II program has been instructed to hold local governments harmless as it looks to save $2.5 billion in order to close the Medicaid shortfall, Gov. Andrew Cuomo said during his Fiscal Year 2021 Budget Address Tuesday.

But in order for the state to continue paying for counties’ Medicaid increases, Cuomo proposed that counties have to both keep their budgets within the 2% property tax cap and manage their Medicaid programs so they do not exceed 3% growth.

Essex County Manager Dan Palmer said the problem with the latter is that counties have very little control over how Medicaid spending is actually determined.

“We deliver service, but the applications and who qualifies for service and everything is determined, not by our people, but by the state.”

Income eligibility

Medicaid spending comes from many directions, Palmer explained, including court orders and uninsured people’s hospital stays.

“It has, essentially, an income eligibility requirement. If the individual meets that income requirement, then they’re entitled to benefits.”

Essex County plans to take a historical look at the period of time since the state implemented the Medicaid spending caps to determine if 3% is a realistic number.

“It will be a bear,” Palmer said. “It is for everybody and I understand it is for the state as well.”

“Blank check syndrome”

Clinton County Administrator Michael Zurlo said the county is not overly concerned about the tax-cap compliance contingency, since its budget has been compliant with that requirement for eight years.

But he took issue with what Cuomo described as counties’ “blank check syndrome” whereby they “have no financial accountability because, no matter what, their costs stay flat,” the governor said.

“The blank check syndrome that he referred to in his speech does not exist,” Zurlo said.

“There are little or no tools that … county governments have to control the cost of the state-regulated Medicaid program. We follow their guidelines.

That being said, Clinton County along with all counties are going to work with the legislature and the governor to try to come up with a solution.”

Zurlo added that the county continues to be appreciative of the state’s takeover of the growth of Medicaid.

“They deserve kudos for that.”

Honor freeze

State Sen. Betty Little, R-Queensbury, said she did not want to see counties and local taxpayers pay any more than they already do for Medicaid.

“I think we should honor the freeze in growth enacted years ago because I don’t think there’s a lot our counties can do to control Medicaid growth,” she said, noting that, if there is, she would like to know in precise terms.

Assemblyman D. Billy Jones, D-Plattsburgh, said he strongly supports the need to control the rising costs of Medicaid services, but argued that it “cannot come at the cost of putting another unfunded mandate on our local governments.”

“North Country families already have enough bills on their plate and shouldn’t be forced to bear even more of the state’s burden,” Jones added.

Assemblyman Dan Stec, R-Queensbury, said the state could be doing a lot more to combat fraud, waste and abuse in Medicaid.

“To blame the counties, I just don’t think is going to be well received locally.”

Plattsburgh Town Supervisor Michael Cashman felt there was a shared interest in protecting Medicaid.

“I will be engaging in more conversations with our County Administrator Mr. Zurlo about how those deficits may potentially impact the local municipalities including, of course, county government.”

While City of Plattsburgh Mayor Colin Read acknowledged coming Medicaid reforms, he noted that, so far, those changes weren’t expected to affect his municipality’s operations.


Press-Republican Staff Writer McKenzie Delisle contributed to this report.


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