New York’s Medicaid program ran billions of dollars over budget during the first half of the fiscal year, adding to signs of a brewing fiscal crisis in Albany.

According to the September cash report from the comptroller’s office, posted Monday, state-funded spending on the safety-net health plan totaled $19.7 billion through the first six months of fiscal 2024 – which was $2.8 billion or 16 percent more than projected in the Budget Division’s financial plan.

Because of differences in accounting between the two branches of state government, the comptroller’s cash reports do not always exactly match spending as recorded by the Budget Division. As seen in the chart below, however, the disparity has gotten significantly wider in recent months.


The Budget Division's projected cash flow for fiscal 2024 was front-loaded, anticipating that the state would spend 62 percent of its annual Medicaid budget during the first half of the year. Expenditures reported by the comptroller during that period totaled to 72 percent of the years' budget.

To end the year on budget, Medicaid officials would have to spend less than half as much over the next six months as they did during the past six months.

Governor Hochul and Legislature were already facing a $10 billion projected gap in next year's budget, which has likely gotten larger due to an unanticipated surge in immigration-related expenses, among other factors. Medicaid's cost overruns are likely to compound those future challenges – and possibly opening a hole in the current year's budget.

About the Author

Bill Hammond

As the Empire Center’s senior fellow for health policy, Bill Hammond tracks fast-moving developments in New York’s massive health care industry, with a focus on how decisions made in Albany and Washington affect the well-being of patients, providers, taxpayers and the state’s economy.

Read more by Bill Hammond

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