Striking A Balance Between NY’s Medicaid Costs And Services – Part II

Legislative Column from Assemblyman Marc W. Butler (R,C,I-Newport)
February 8, 2012

As I described in my last column, it has become increasingly clear that New York State’s Medicaid costs are growing at unsustainable levels, a matter that is causing me great concern. The humble 1966 Medicaid program has expanded exponentially since that time, placing our counties, which administer the program, and taxpayers, who pay for the services, in an untenable position of supporting the state’s largest unfunded mandate in the midst of shrinking local budgets. New York’s version of Medicaid care is costing us over $1 billion a week; the circumstances are dire and something must be done immediately to ensure that these services remain available to those who need it the most without breaking the bank for everyone else.

Gov. Cuomo has called for a gradually implemented cap on cost increases to Medicaid and an eventual consolidation of administrative responsibilities at the state level. Good as far as it goes, but efforts which still fail to correct the underlying causes of Medicaid’s ballooning expenditures.

Counties have been directed by the state to administer and fund Medicaid at the local level for nearly 50 years. Some experts have estimated that, without this local involvement, far more individuals would have enrolled under New York’s already generous eligibility rules. If the state takes over the administrative duties, the incentive to control excessive enrollment is lost, and may very well lead to more beneficiaries than our local taxpayers can afford to pay.

Many county officials are advocating for a full state take-over of Medicaid costs. Currently, counties pay for roughly 25 percent of the cost. I am co-sponsor of a bill that would allow for the gradual takeover of those costs, which amount to about $8 billion annually. The problem again is that if the costs do not change, the state must raise an additional $8 billion or cut other programs. Do we raise income taxes or business taxes? Some argue that it is a fairer way to raise the needed revenue, since the value of your home, and correspondingly, your property taxes do not necessarily reflect your income or wealth.

A classic example of this is a retiree living on one of our beautiful lakes, who has seen the value of their lakefront property rise dramatically, but has seen little or no increase in their pension or social security.

I’d like to see our county governments have more control, not less, over Medicaid’s costs. New York’s counties are more in tune to the needs of their own communities both in what they can afford and what unnecessary programs can be opted out of. If Albany refuses to give counties this freedom, then it must resume the responsibility to pay for its mandated extended services, not simply take on a few more administrative duties down the road.

Furthermore, Medicaid fraud, waste and abuse continue to run rampant in New York State, cheating both those who need the services and those who are paying for them. Yet, Gov. Cuomo cut $4.5 million from programs in the state that target the misuse of Medicaid and the efforts to prevent it. I certainly believe that keeping a close eye on this problem is important, and we must stand on the side of taxpayers to support such efforts to ensure our public dollars are used lawfully and effectively.

This is a simple matter of affordability: If we don’t control the costs of Medicaid, I fear that the program’s sustainability will be compromised, jeopardizing it for those who may need services in the future. Furthermore, without controlling the cost shift placed on county governments and their taxpayers, we risk pricing families out of their communities – and right out of New York State.

If you have any additional questions or ideas about Medicaid’s sustainability in New York, please e-mail me at or call my Herkimer office at (315) 866-1632 or my Johnstown office at (518) 762-6486.