ALBANY — Gov. Andrew Cuomo took to the stage for his 2020 State of the State address Wednesday, highlighting a reel of his administration’s accomplishments over the last decade and introducing dozens of his proposals for the new legislative session.
Cuomo’s agenda was ambitious, he admitted, including investing in environmental protections, expanding women’s rights and legalizing recreational marijuana — an initiative he pushed for last year, but was foiled by the Legislature over disagreements on regulating the industry and where revenue should go.
But to Republican lawmakers, other government officials and citizen groups, Cuomo skimmed over one of the biggest issues facing the state this year: a $6.1 billion budget gap, largely attributed to a $4 billion deficit from Medicaid costs.
“While he was saying spend, spend, spend, spend, spend, he did mention in the middle of his speech, it was very brief, the $6 billion budget gap,” said Assemblyman Mark Walczyk, R-Watertown. “I have some serious concerns because ... here it looks like the governor is going to spend and shift mandates onto counties to make up for that shortfall.”
Cuomo brought up the budget gap and Medicaid costs in the middle of his speech, first by touting that 95 percent of New Yorkers have health care coverage — an unprecedented number. But that achievement came at a cost, Cuomo said.
“Six years ago, we froze the cost of Medicaid to local governments to help local governments meet their property tax cap,” he said. “The local governments still administer the program even though they no longer share the costs. It is too easy to write a check when you don’t sign it.”
Cuomo called the situation unsustainable and went on to suggest restructuring the Medicaid program, but did not clarify in his speech what that restructuring would look like.
Many audience members, like Walczyk interpreted it to mean the costs would be shifted back onto localities. Later on, Cuomo’s secretary, Melissa DeRosa, said that would not happen.
“When the state took over the growth in Medicaid costs and held the local governments’ harness but allowed the local governments to continue administering the Medicaid program, there was a loss of control in terms of how the money was being spent, when it was being spent, why it was being spent, and that has created structural issues that now have to be addressed,” DeRosa said. “There is without a doubt waste, fraud and abuse within the system.”
A Cuomo spokesman said more details would be available in the 2020 budget, which is due Jan. 21.
But Republican legislators remain concerned about what a Medicaid redesign would mean for their districts.
Walczyk said changes to Medicaid costs could be “devastating for the north country.”
According to the latest data from the state Department of Health, there was an average of 4.8 million Medicaid beneficiaries in New York each month. While the majority of non-New York City beneficiaries reside in western New York, nearly 41,000 were in Jefferson and St. Lawrence counties combined.
“I agree with (Walczyk) wholeheartedly,” said Assembly Minority Leader William Barclay, R-Pulaski. “The whole purpose we put that provision in for has been a great relief for property taxpayers in New York. [Changing] that would have a catastrophic effect on taxpayers.”
In their own proposal to balance the 2020 budget, Citizens Budget Commission recommended reducing Medicaid costs to close the budget gap, and commended the reinstitution of the Medicaid Redesign Team.
But they warned against shifting costs back onto localities, with David Friedfel, director of state studies, saying such a move would be “regressive.”
The New York State Association of Counties, which was a member of the first Medicaid Redesign Team, applauded Cuomo for freezing the local share of Medicaid.
“Counties have a long history of working with the state to bring efficiencies,” the Association said in a statement. “We look forward to providing the county perspective and contributing to future discussion to create a more fiscally sustainable Medicaid program for state and local taxpayers.”
Massarah Mikati covers the New York State Legislature and immigration for Johnson Newspaper Corp. Email her at email@example.com, or find her on Twitter @massarahmikati.