Please don't budget on care

Something is going on in Albany that should make all New York City residents very nervous.

There is a projected $6.1 billion deficit in the state budget, and if history is any guide, the state will look to the city to plug this massive hole.

Last session, Albany passed several criminal justice reform bills without a plan to allocate sufficient state dollars to implement these programs. Now the state is again planning to solve its budget deficit by raiding city coffers, announcing new cuts to state funding of Medicaid, and leaving local governments to foot the bill.

Under the proposed state budget, Albany plans to do away with the cap on local spending, effectively absolving the state of its commitment on Medicaid cost-sharing.

The state now expects local governments to pay for annual increases in local Medicaid spending exceeding 3 percent, putting in place an “incentive- and disincentive-based system” which, in practice, will place the cost burden on the shoulders of local taxpayers, and punish localities where the need is greatest.

New York’s program always has been among the largest and most expensive in the country in terms of size of enrollment and cost due to its inclusive eligibility criteria and service offerings. The comprehensive nature of the New York Medicaid program always has been a point of pride because it enshrines our belief in casting the safety net wide and reaching all New Yorkers in need.

If the state’s plan is meant to reduce costs by disincentivizing care, this will most certainly mean reducing services for the poorest members of our community — 6.4 million low-income New Yorkers, including children, parents, pregnant women, seniors, and people with disabilities who would not be able to afford health care were it not for Medicaid — and substantially narrowing the scope of the program.

As a city councilman, it is my job to ensure the city has a responsible budget, and that means not sitting idly by while the state tries to offload its responsibilities onto local governments and taxpayers. In New York City — which makes up the greatest share of the state’s Medicaid recipients and spending — the governor’s plan would force city lawmakers to choose between providing quality, reliable care, and a range of budget priorities, including public assistance, homeless services, education, affordable housing, public transportation, and infrastructure.

Estimates put the additional Medicaid contribution for New York City at $1.1 billion — hundreds of millions of city dollars, which will need to be reallocated from other essential programs at great human cost.

The city is doing its part and consistently paying more than its fair share to keep New York and these programs running, but we cannot continue to be the state’s perpetual piggy bank. Albany continues to rely on New York City’s tax base to fund the bulk of state services that the city’s residents have little say over. The city pays a disproportionate share of the state’s responsibility to keep the MTA running, but has a minimal role in deciding how these funds are used.

New York is one of the only states in the country that requires localities to pay for the cost of Medicaid, and local governments here already are paying the largest share of Medicaid costs nationwide, despite having little administrative control over the program.

For the 2019-20 fiscal year, the federal government will pay about 57 percent of the cost for Medicaid. The state will pay about 33 percent, and New York City and local counties will pay the remaining 10 percent. Under the new proposal, this amount will grow and continue to undermine the city’s finances.

The combination of prudent budgeting and a vibrant economy has allowed the city to set aside money for a rainy day, but these resources are not for the state to raid. The state should be responsibly budgeting and not skimming savings from Medicaid by shifting the cost of care onto local governments. In the event of a downturn in the city’s economy, we must have these funds to rely on.

All this is not to say there are not inefficiencies and sources of waste in the program that can be addressed to rein in costs. We must work aggressively to target fraud and abuse to ensure that the program continues to serve the people who need it. Hospitals and health care providers must be held to account for predatory billing practices.

Medicaid can be more efficient and continue to provide services and support to the millions who depend on it without shifting the cost of care to the people and families who should be at the heart of these conversations.

The author represents the 11th district on the city council, including Riverdale, Kingsbridge and Van Cortlandt Village.

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