Tompkins County officials are ramping up efforts asking Governor Kathy Hochul to reconsider her plans to shift $625 million in Medicaid costs to county governments by intercepting eFMAP funds. Tompkins County has estimated that the 2024 budget impact would be $1.5 million (equal to a 3% increase in the local property tax levy) and that there may be a $600,000+ impact in 2023 when the State policy goes into effect.
These eFMAP funds originate from the Affordable Care Act (ACA) and have always been intended in-part for counties in New York State. The ACA provided nationwide Medicaid coverage to newly eligible populations, though in New York State those populations were already covered by State programs. In the Affordable Care Act, the Federal Government agreed to pass eFMAP funds on to New York State and its counties to cover those costs. Traditionally, New York State has passed eFMAP funding to county governments, as was intended by Congress with the passage of the eFMAP provision. This new proposal by the Governor upends that traditional cost-sharing arrangement, instead keeping those federal dollars at the State level and forcing a higher share of the cost back onto counties, which is estimated to total $625 million in 2024.
Tompkins County Administrator Lisa Holmes stated, “If the State’s goals are to increase affordability and provide robust services to those in need this is an unwise proposal. Shifting the costs onto counties adds more burden to the local governments that carry out much of the work that the State takes credit for. This would make it more difficult and expensive for us to do that work and will result in increased property taxes, which in-turn impacts affordability.” Holmes continued, “While it is mandated by the State that counties pay for Medicaid costs, we have no local control over those costs or how they’re spent.”
Legislator Deborah Dawson, who chairs the County’s Budget, Capital, and Personnel Committee stated, “It’s imperative that the Governor change course on this. Counties would be left picking up the tab while the State pockets billions. The Governor’s budget proposes $5.5 billion more added to State reserves while charging Counties an additional $625 million – it just doesn’t add up as a sensible and fair proposal. If the state is going to intercept money from counties, then I expect that they will be granting more dollars to our municipalities and delivering more services directly to our residents – otherwise it’s nothing more than saddling the local taxpayer with a higher bill for no new returns on that investment.”
Chairwoman of the Tompkins County Legislature Shawna Black stated, “This is simply unsustainable. It’s a small amount for the State to absorb in their budget, but a huge amount for counties to absorb in ours. We may be left with no choice but to pass the cost on to local property taxpayers, or to cut services that our public depends on. Draining more funds from local governments makes delivering services and meeting the needs of our communities harder.”
Chairwoman Shawna Black spoke about the eFMAP fund issue during the meeting of the Legislature on February 7, and a resolution was unanimously passed calling on the State of New York to continue to pass the funds through to Counties on February 21.