LITTLE VALLEY — No budget issue has caused Cattaraugus County Administrator Jack Searles more frustration than Medicaid — specifically the state’s looming $6 billion deficit from the program.
Searles, who attended the annual New York Association of Counties Legislative Conference in Albany earlier this week, heard Gov. Andrew Cuomo threaten in his budget message to remove the current cap on counties’ Medicaid costs.
The state has already notified counties it will increase their Medicaid contribution in the state’s 2020-21 fiscal year, a move that will cost Cattaraugus County at least $1 million, Searles said.
The move comes after county lawmakers adopted a $250 million budget in November.
“We were formerly held harmless for any growth in Medicaid,” Searles said in an interview Friday after returning from the NYSAC conference. The governor has threatened to remove that longstanding cap.
Searles said Medicaid is a mandate over which the counties have no control. New York’s Medicaid program is among the most robust in the country.
By the state picking up increases in counties’ Medicaid costs in recent years, counties were able to stay under the property tax cap, Searles noted. If counties are again expected to pick up a share of rising Medicaid, it would be difficult to stay under the cap, and exceeding the tax cap would cost counties in Medicaid reimbursement — and property owners would face even higher taxes.
“We are being blamed unjustifiably,” Searles said
Searles said the county’s share of 2020 Medicaid costs are expected to be about $19.5 million. That’s 35.2% of the county tax levy. That was before Cuomo raised the specter of a $6 billion budget deficit that is largely Medicaid.
Even Comptroller Thomas DiNapoli told county officials attending the NYSAC conference the issue was not generated by counties, Searles said.
A new Medicaid redesign team was charged with coming up with recommendations for the governor by April 1. The state budget is due to be passed the day before.
The county has no control over Medicaid costs, Searles said. The 2019 increase was 12.9%, 19.1% in 2018-19; a drop of 8.6% in 2016-17, and a 41.1% hike in 2015-16.
“It goes up and down,” and is unpredictable, he said.
One of the driving forces on Medicaid costs was the state directive to pay healthcare employees $15 an hour, Searles said.
Another gubernatorial initiative would cap the federal percentage going to counties, Searles said. Rather than share in any future federal Medicaid increases, the state would preempt that revenue.
“It assumes that you are able to contain costs — when we don’t control these costs,” Searles said.
By removing the 3% cap on Medicaid reimbursement, he said, anything higher would become the responsibility of the county.
The governor’s Medicaid proposals threaten the single largest tax reduction program he has helped enact — the 2 percent property tax cap — by relieving counties of the cost of the growth of Medicaid.
Once it is appointed, the Medicaid Design Team will be charged with finding $2.5 billion in Medicaid savings. “It hasn’t been appointed and it’s very short on details. There are no indications of what these reductions are going to be.”
Searles emphasized that this Medicaid crisis isn’t just going to just impact the county.
“This will reverberate across all healthcare providers in Cattaraugus County,” the county administrator said. “I’ve never seen anything like this.”
Searles said, “You have the governor clearly pointing the finger at counties to contain costs. We have no ability to contain these costs. New York owns Medicaid program growth.”
(Contact reporter Rick Miller at firstname.lastname@example.org. Follow him on Twitter, @RMillerOTH)