Medicaid is a joint federal-state program. As such, payments are made by both the federal government and state government. However, that simple dichotomy can be deceiving, because it lumps the actual state government with the local governmental entities (like counties). Each state can operate differently, but in New York, the “state” portion of the bill is actually divided between the government in Albany and local governments.
This payment system has actually led to much controversy in recent years, mostly as counties have struggled to keep up with their obligations. The New York Medicaid system is the largest in the country, and that comes with significant costs. Many county officials have argued that it is becoming increasingly impossible for the local governments to keep up with costs–particularly as those costs have risen.
Some counties are going to significant lengths to cut Medicaid obligations. For example, recently one county–Oneida–hired a team of lawyers in an attempt to recoup Medicaid payments that it believes were above their obligations. According to WKTV, the county is arguing that they are owed somewhere between $4 million and $6 million from New York State. The discrepancy stems from overpayments allegedly made by the county for in-house care for those with mental illnesses.
Changes for the Future
Little information has thus far been provided on the merits of the county’s claims or their likelihood of success in getting money from the state. However, regardless of the outcome in this particular state-county dispute, most observers believe big changes are in the works for New York Medicaid payment arrangements.
In particular, all of the state portion of Medicaid is likely to be taken over by the state. This will relieve the county the burden of paying for a portion of the costs–generally through property taxes. A gradual takeover was already approved which should transfer the counties “three percent” portion onto the state.
One member of the state’s Medicaid Redesign team summarized the situation thusly: “New York recently phased in a gradual takeover of the three percent local share of Medicaid costs, but I believe that more must be done to bring down costs for local property taxpayers. Counties have no control over the rules or eligibility for Medicaid, but county taxpayers are stuck paying for a significant portion of the cost. This must end.”
On top of that shift, many lawmakers are still urging changes to the system in order to make it more viable in the long-term. Those changes might include even more aggressive approaches to save on overspending. Changes to eligibility or other rules may also be in the works down the line. Local residents should remain attuned to any changes so that they can adapt their own long-term care plans if necessary.