October 20, 2021

Medicaid change could cost Cortland $1 million

Cortland County Seal

Cortland County taxpayers could see a $1 million or more increase in Medicaid costs if the state shifts the burden in spending increases in the state’s 2020-21 budget. Or maybe they’ll see no increase at all.

“The fallacy in the rhetoric about this proposal is that counties actually control Medicaid costs,” said Kristen Monroe, Cortland County’s social services commissioner. “Counties in New York state do not control factors that determine cost. Counties do not establish eligibility guidelines, benefits offered, reimbursement rates, utilization thresholds, provider contracts, prescription costs or demographics. In fact, local departments of social services are mandated by state law to make accurate and timely eligibility determinations for Medicaid in compliance with policies set by the state.”

Legislators will consider Feb. 27 sending a letter to the governor, the state legislature and the Medicaid Redesign Team II — set up to find $2.5 billion in savings from the program — urging them to preserve the zero percent Medicaid growth cap, meaning the county would not need to pay extra if the county sees an increase in Medicaid spending.

Gov. Andrew Cuomo proposes forcing counties that exceed 3% growth in Medicaid spending to pay the cost beyond the 3% themselves, rather than the state. That would be regardless of whether the increase is because more people need Medicaid services, or whether the cost of care goes up. The cost of care has risen an average of 5% a year between 1991 and 2014, reports the non-profit Kaiser Family Foundation.

That could mean property taxpayers could end up paying more.

More than 6 million disabled and low-income New Yorkers get their health care coverage from Medicaid. In Cortland County, about 11,800 people receive Medicaid benefits, Monroe said.

Using data from the past five years, Monroe said the county would have had to pay anywhere from $500,000 to almost $1 million to the state for three of those years had this proposed policy been in place.

“We need to be even more cautious, however, because it is not clear how the proposed changes might use, or not use federal Medicaid funds to offset the county’s share of Medicaid,” Monroe said.

The county pays $187,173 a week — $9.7 million a year — to the state for its share of Medicaid. The cost is about two-thirds of the Department of Social Services budget and around one-third of the property tax levy.

Tompkins County is in the same boat.

Tompkins County legislators were in Albany last week as part of Advocacy Day in which they met with state representatives on the topic.

“The governor’s proposal would cost Tompkins County more than $1.5 million, which is a 13% increase in our Medicaid share,” said Legislator Shawna Black (D-Ithaca), who was the then-interim chairwoman of the legislature. “We couldn’t just raise property taxes enough to cover it; that would be a 3% property tax levy by itself.”

Tompkins County pays $219,478 a week for Medicaid, for a total of $1.54 million since the start of 2020.

State Sen. James Seward (R- Milford), the ranking minority member of the Senate Finance Committee, said he had hoped there would be more constituencies represented on the redesign team.

“County officials, ambulance providers, and upstate voices, among others, were left off by the governor, meaning key demographics will not be heard from during this crucial examination of our Medicaid system,” Seward said.

CNHI News Service contributed to this report.