A report issued this summer by the Empire Center for Public Policy, a nonpartisan think tank based in Albany, indicates Chemung County is one of two counties that shoulder the heaviest Medicaid burden in upstate New York.

The report, written by Empire Center Director of Health Policy Bill Hammond, also examines a possible shift of Medicaid costs back to the state, although Hammond  admits that will be a difficult task.

In fact, real reform and cost savings could take years to achieve, he said.

Chemung County Executive Tom Santulli has long been a leading critic of New York’s Medicaid policy, and an advocate for changes that will bring counties relief.

The state has made some changes in recent years that have helped ease that burden, but Medicaid remains an expensive unfunded state mandate, Santulli said.

“It’s become a $70 billion program in New York state. That’s bigger than some state’s entire budgets,” he said. “There’s a $7.6 billion local share. Sixty-five percent of our tax levy goes to pay for Medicaid. Gov. Pataki put a cap on Medicaid costs and Cuomo gave us a hard cap. It’s still a big burden. If the state took over our local share, we could reduce our tax levy by 65 percent.”

A major expense

Prior to the cap, Medicaid costs ate up more than 100 percent of the county’s property tax levy, Deputy County Executive Mike Krusen said.

Chemung County, which has 85,000 residents, spends $19.5 million on Medicaid expenses, Krusen said.

In contrast, Tompkins County, with a population of 104,000, spends only 11.5 million on Medicaid, while Steuben County, with 96,000 residents, spends about $20 million, he said.

Chemung County’s Medicaid burden is high because it has 20,000 residents who are in the program, Santulli said.

That trend started after the 1972 Agnes flood, he added, when many Elmira residents fled for the suburbs, and out-of-town landlords started buying up properties and converting them to low income housing.

Many of the people who moved into the area following the flood were poor and needed help with medical bills, Santulli said.

Medicaid is a federal program, with the federal government picking up half the cost and states covering the rest.

New York is one of several states that pass a portion of its cost onto counties, but New York’s version is one of the largest, most generous and costliest Medicaid programs in the country, Hammond said.

The Empire Center report, utilizing figures from the New York State Association of Counties and the state Comptroller’s Office, shows that when all property tax levies are combined, including county, municipal and school taxes, the Medicaid local share makes up 15 percent of that total in Chemung and Oneida counties.

Most other upstate counties fall in the 5 to 10 percent or 10 to 15 percent range, according to the report.

There are several reasons Chemung and Oneida counties are hit the hardest, Hammond said.

“One is the general poverty level of the region. You would have more people who qualify for Medicaid and the need for health coverage,” he said. “But at the same time, you also have a general rule that property values are lower and sales tax revenue is lower. As a share of the ability to pay, Medicaid becomes a larger factor.

“That’s what is the core unfairness of the system,” Hammond said. “If you make local resources a major part of finances, you’re going to have that effect. It will be regressive and harder for low income areas to afford.”

Looking for long range solutions

Simply shifting the cost back to the state isn’t a viable solution either, Santulli said, since state taxpayers would then have to absorb that $7.6 billion local share.

Instead, the program itself needs to be overhauled, he said.

“It can’t be resolved without changing something. Medicaid is not like this in every state,” Santulli said. “You have to change the program, which is not easy to do. Once you have all these things, it’s very hard to change that momentum. To walk it all back is no easy task.

“A lot of people are going to multiple doctors and nobody is monitoring results,” he said. “A lot of (the solution) is more oversight.”

Hammond agrees it wouldn’t be practical or politically realistic to have the state take over the full cost of Medicaid.

However, the good news is the trend is toward lower costs, but it will take several years to see substantial savings, he said.

“You have a very gradual phaseout of the local share. It doesn’t seem that way because it’s the same dollar amount. But due to inflation, the real cost of the local share is gradually getting smaller, a couple percentage points a year,” Hammond said.

“It’s frustrating to the people who have to pay the bill, but any realistic system for phasing it out would be gradual,” he said. “Maybe 20 years down the road, it will be a much smaller cost, even in Chemung County. It’s a serious problem, but also one that’s getting smaller over time.”