County taxpayers could bear burden of higher Medicaid costs

Jan. 24--Orange County taxpayers have been spared the financial toll in recent years as Medicaid enrollment has climbed to more than a quarter of the county's population and the annual cost of care for those patients has approached $1 billion.

But Orange and other counties across New York could face higher Medicaid bills again under a budget proposal by Gov. Andrew Cuomo that would lift a five-year freeze on their shares of the expense if their costs rise by more than 3 percent in a year.

Cuomo says he wants to prod counties to rein in Medicaid spending -- or share the burden if they fail to do so.

But some county officials argue their departments have little ability to reduce Medicaid spending, other than to continue and maybe increase their efforts to root out fraud and abuse by providers and enrollees. After all, the state itself determines who's eligible and what services are covered under the government health insurance for the poor, elderly and disabled.

Decisions about provider payments and patient co-pays are also made in Albany.

"It leaves me with very little choice in terms of what I can do with my Medicaid spend," said Joseph Todora, commissioner of Sullivan County's Division of Health and Family Services.

Rising Medicaid costs had long been a concern for New York City and the 57 counties in the rest of the state, which share the expense with the state and federal governments. The state responded first by capping counties' increases at 3 percent in 2005 and then by lowering that limit to zero in 2015, freezing county contributions and pushing all added costs to Albany.

That freeze was meant to ease pressure on counties and help them meet the 2 percent limit on property-tax increases that the state imposed in 2011. But Cuomo argues it also caused counties to be less vigilant about rising costs.

"It doesn't matter what they spend," he said in his budget speech on Tuesday. "Their cost does not go up. It doesn't matter what they save, they don't get any savings. That never works. In private transactions, they always want everyone to have skin in the game."

Under his budget proposal, counties in which Medicaid expenses go up by more than 3 percent in one year would have to pay all or part of the costs over 3 percent. Those with increases under the limit would pocket 25 percent of the savings.

The 3 percent target could be difficult to reach. In Orange County, overall Medicaid spending rose by 6.7 percent in 2017 and 6.5 percent in 2018, totaling nearly $927 million that year, according to the county Department of Social Services. As of last April, the county had almost 105,000 residents enrolled in Medicaid, or 27 percent of the population.

Mark LaVigne, deputy director of the New York State Association of Counties, said his organization was seeking clarification on how the 3 percent cap would be calculated and applied, but believes it wouldn't affect counties in 2020 by saddling them with unexpected Medicaid costs. The change would start with their budgets for next year.

Todora said one spending area ripe for deeper fraud scrutiny was the taxi rides Medicaid enrollees take, although he acknowledged that was a relatively small piece of the program's costs. One of the biggest expenses, he said, was the care for people living out their final months in a hospital or nursing home -- a type of service he said should be spared from cuts.

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