Medicaid Continues To Bedevil State, Local Budget Writers

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Medicaid Continues To Bedevil State, Local Budget Writers

By Joel Stashenko, Associated Press via Newsday
November 13, 2003

George Pataki, in his first State of the State address to the Legislature as governor in 1995, called the cost of the Medicaid program in New York state "staggering."

Pataki declared that Lt. Gov. Betsy McCaughey and state Health Commissioner Dr. Barbara DeBuono would work to revamp the $22.5 billion program and rein in costs to help state and local taxpayers.

"Today, New York 's Medicaid system costs three times as much per recipient and often delivers a quality of care inferior to the programs run by other states," the new governor said.

Nearly nine years later, McCaughey and DeBuono are long gone from Pataki's administration, New York still spends three times more on Medicaid per recipient than some other states and the program costs federal, state and local taxpayers an even more staggering $26 billion.

County legislators and administrators across New York state have been engaged this month in the grim task of proposing their budgets for 2004. In almost every case, they're contemplating double-digit tax increases, sales tax increases or extensive service cuts. Their most often-cited excuse is the need to pay for the state-mandated local share of Medicaid costs.

Tioga County taxpayers, for instance, are facing a 19.8 percent tax increase after paying nearly 12 percent more in property taxes in 2003. Medicaid consumes $6 million of the $53 million budget in that Southern Tier County. Oswego County officials are tentatively looking at a 43 percent property tax increase to help pay for escalating Medicaid costs that have risen $8 million since 2001.

The executive director of the state Association of Counties, Robert Gregory, is talking about the "crisis" counties are facing because of Medicaid and public pension contribution costs. County leaders are especially angry because they get the bills from the state for both programs and have little, if any, say over either.

The New York City-based Citizens Budget Commission this week identified New York 's highest-in-the-nation Medicaid costs as a persistent drain on both state and local budgets, and said the expense of the program is a major reason New York has the highest local taxes in the nation.

The group said New Yorkers pay 72 percent more than the national average in local taxes and 26 percent more than the national average when the local and state tax burden is considered jointly.

The Citizens Budget Commission numbers affirm what the state's business community has long been complaining about, said Robert Ward, head of the Business Council lobbying group's research arm.

" New York is 26 percent above the national average, while our closest competitor state ( California ) is only 8 percent above the national average," Ward said. "To put this in layman's terms, the report shows that taxes in New York are not just high _ they're extremely high."

Speaking of California , the Citizens Budget Commission found that the Golden State pays an average of $2,155 to each Medicaid beneficiary. New York pays $7,646.

In addition to providing the most treatment services of any state's Medicaid program, New York also uses Medicaid dollars for other health-related purposes, such as to help fund teaching hospitals. The care of many elderly, disabled New Yorkers is paid out of the program through what the Citizens Budget Commission said are the state's "generous" eligibility rules.

Assembly Speaker Sheldon Silver said the disproportionately high cost of Medicaid in New York is no mystery.

"The average age of New Yorkers is far higher than California 's," Silver said this week. "The AIDS incidence ... is far higher than California and Texas ."

Like elderly New Yorkers who need round-the-clock care, AIDS patients similarly require intensive medical attention, plus an expensive drug regimen. If those patients do not have private insurance or personal wealth, taxpayers end up footing the bill.

Two-thirds to three-quarters of the state's Medicaid budget is used on care for the elderly and people with HIV and AIDS, Silver said.

Rather than bemoan the high cost of Medicaid, the Democratic legislator said New Yorkers could look on the program as a successful deployment of taxpayer assets: "We're getting the federal government to pay half of it."

Still, the outlay of state and local taxpayer funds necessary to leverage that $13 billion or so in federal Medicaid spending is an increasingly tough burden for New Yorkers to bear, particularly in a bad economy.

County taxpayers will find that out in the next few weeks. State taxpayers' turn will come next spring after Pataki and the Legislature make their next budget.