From Steuben County Chairman of the Legislature Scott Van Etten, R-Caton
To step back, the Medicaid program was enacted by the federal government in 1966 with the feds and states sharing the costs equally. New York chose to have counties and New York City pay for half of the state share. In fact, New York is one of the few states in the nation that have local taxpayers fund any portion of Medicaid costs, and over the following decades, Medicaid costs grew exponentially. Counties continued to push for the state to cap our costs or take over the program entirely. Governor Cuomo and the legislature finally heard our pleas, and in 2012 the state adopted a freeze on local Medicaid costs, fixing increases at 3 percent per year, while the state picked up the remaining growth. It was the largest meaningful mandate relief we have seen in years and made adherence to the property tax cap much more attainable.
Now, the Governor’s proposal to close the state budget deficit would undo these promises. His plan is essentially two-fold
1) Intercept Enhanced Federal Medical Assistance Percentage (eFMAP) payments from the federal government that Steuben and other counties currently receive.
◼ Under the Affordable Care Act, states such as New York that historically offered Medicaid services exceeding basic standards received additional federal reimbursement through eFMAP. Steuben’s share of eFMAP averages $1.6 million per year -- an amount that is vital to our county budget.
2) If a county exceeds the Property Tax Cap OR if local Medicaid costs grow more than 3 percent in a year, the counties would be responsible for the overrun.
◼ The estimated first year impact to Steuben would be an additional $1.5 million and increase every following year.
Combined, that’s more than $3 million additional cost in the first year. To make up this difference, the county would have to raise property taxes by approximately 6 percent -- an additional $47 to an average homeowner in Steuben. Or the county will have to reduce local services that our residents depend upon. In addition, there are a number of major issues with the Governor attempting to hold counties accountable for the Medicaid deficit. First, counties have no meaningful control over the program – we do not set eligibility requirements or income thresholds, we do not choose which services are available to those that qualify, and we do not manage the contracts or payments of Medicaid providers. The state also has chosen to offer nearly all of the 28 optional services under Medicaid; a choice not made by the counties. Our staff is responsible for helping the state with processing applications -- these tasks are critical to the program, but the county and our caseworkers cannot change the state’s guidelines.
Medicaid costs in Steuben County have increased by over 10% annually in recent years because of the state’s Medicaid expansion. The total Medicaid cost, including federal, state, and county share exceeded $220 million for 2019, with no expected relief in sight. Cost of long-term care, services for the elderly, and prescription drugs have largely driven these increases, all of which, the county cannot control. Punishing counties for growth above 3 percent just sets us up for failure and more financial burden for the taxpayers.
Our message is simple – the level of government that ultimately controls a program should pay for it and not pass on costs because it is the easy thing to do. Albany caused this fiscal crisis, and Albany should find solutions that do not cost Steuben taxpayers an additional $3 million. The Governor has re-established a Medicaid Redesign Team to look at all aspects of the system and find efficiencies, and Steuben and partner counties have submitted recommendations to this team. We say let them do their work and find meaningful reforms instead of picking the county taxpayer’s pocket.
We urge residents to contact the Governor’s office and your state officials and tell them that it is unacceptable to rely on your local tax dollars to fix a state problem.
