In his one ‘State of the State’ reference to Medicaid’s overspending crisis, Governor Cuomo pointed the blame at local governments—and implied that he might hit them up for a bailout. That’s a fundamentally wrongheaded approach. The only real solution is to control costs, not shift them to local taxpayers.

NY already shifts more of its Medicaid costs to local government than any other state. It’s the ultimate unfunded mandate. To their credit, the governor and Legislature have frozen the local share since 2015. The total amount is about $7.6 billion, including $5.3 billion from New York City and $2.3 billion from the other 57 counties combined.

If Cuomo is concerned that local decision-making is contributing to higher costs—which is possible—then he should centralize decision-making.

For more background on local government’s financial role in New York’s Medicaid program, see Bill Hammond’s 2018 report, “Shifting Shares: The Costly Challenge of a State Medicaid Takeover.”

The Empire Center, based in Albany, is an independent, not-for-profit, non-partisan think tank dedicated to promoting policies that can make New York a better place to live, work and raise a family.