Deborah Dawson

Deborah Dawson - TC Legislator for District 10

3 months ago

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Deborah Dawson - TC Legislator for District 10

6 months ago

NEWS FROM THE COUNTY LEGISLATURE
Every spring, the County Legislature and staff look to Albany to see what impact the New York State budget will have on county government and our taxpayers. This year, the state’s budget process concerns us more than usual, primarily because of the Medicaid cost shift that’s buried in Governor Hochul’s budget.
Understanding Basic Medicaid Funding
Medicaid is a federal entitlement program that provides health and long-term care insurance to low-income families and individuals. States administer their Medicaid programs subject to Federal oversight and subsidy. Medicaid is the largest source of health coverage in the United States, covering almost a quarter of our population.
Medicaid operates and is jointly financed as a partnership between the Federal and state governments, with varying contributions from counties. New York is one of eighteen states that mandate county contributions towards the costs of its Medicaid program. In fact, New York counties make the highest mandated contributions in the country, sending nearly $7 billion a year, or $140 million per week, to Albany for Medicaid costs. Tompkins County’s annual Medicaid contribution of over $10 million is by far our largest mandated payment.
Enhanced Federal Medicaid Funding (“eFMAP”) and the County Contribution
The Affordable Care Act (ACA) sought to expand Medicaid coverage throughout the United States, and rewarded states that had already expanded their Medicaid coverage by enhancing the Federal Medical Assistance Percentage (the amount of Federal matching funds contributed to state Medicaid programs) paid to those states. New York was one of the states that received an enhanced Federal Medicaid Assistance Percentage (eFMAP) under the ACA.
Senator Schumer, speaking for the New York State congressional delegation, made it clear that the ACA eFMAP funding should be shared by state government with the counties. And, for a while, the State did share. Albany estimated that the eFMAP funds would reduce the counties’ contributions to state Medicaid costs by about 20% and reduced the counties’ weekly Medicaid contributions by that amount. It was understood that there would be a reconciliation at the end of each year, with the State paying the counties to the extent that the actual eFMAP funding exceeded 20% of the counties share. The last time reconciliation payments were made was in 2017.
Responses to requests made under the New York State Freedom of Information Law revealed that New York State currently owes its counties several billion dollars in ACA eFMAP reconciliation payments. We are advised by NYSAC and others with knowledge of the State’s finances that those billions are spent and gone.
Governor Hochul’s Plan to Intercept and Keep eFMAP Funds in Albany
Governor Hochul’s budget assumes that all future ACA eFMAP funds will be kept and used by Albany to pay the State’s share of its Medicaid costs, effectively increasing the counties’ mandated share of the program costs. During this next NYS fiscal year alone (4/1/2023-3/31/2024), this will shift $625 million in Medicaid costs to counties and county taxpayers. And, since the Governor has made it clear that she intends to expand Medicaid coverage and increase payments to providers, the amount of the cost shift will only grow every year.
Unfortunately, the ACA eFMAP provisions are not as clear as they should have been with respect to allocating the additional funding between the State and the counties. The change in the Governor’s treatment of the eFMAP funding will be effectuated by the executive agencies’ “re-interpretation” of the ACA (an interpretation that conveniently lets the State off the hook for the billions in reconciliation payments it hasn’t made since 2017), and not by State legislation. That means that the State Senate and Assembly cannot provide a legislative fix, at least not within the State budget process. The Senate and Assembly one-house budget bills propose approximately $625 million in additional aid to counties to make up for the initial impact of the Governor’s proposal, but that will not provide long-term relief to the counties.
Why You Should Care Enough to Read This Far
This cash grab by the Governor will blow a $600,000+ hole in Tompkins County’s 2023 budget. We may have the fund balance to accommodate that, but we cannot use fund balance to sustain the increases in 2024 and beyond. We estimate that Tompkins County’s mandated Medicaid contribution will increase by close to $1.5 million in 2024, an amount that translates into a nearly 3% tax levy increase. Driven by the impact of this one change in the Governor’s budget, our choices will be to increase your property taxes, cut services, or both. And we all know that we’re facing other serious economic issues that will have a substantial impact on our budget decisions for 2024 and beyond.
What You Can Do
To learn more about this issue, you can visit NYSAC’s issue-specific website at www.costshiftcountdown.com/, where you will find tools for citizen advocacy against the Governor’s proposed intercept of the ACA eFMAP funds. And you can communicate your opposition directly to the Governor through the contact form at www.governor.ny.gov/content/governor-contact-form.
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