ITHACA, N.Y. — Tompkins County was largely spared as proposals to rein in Medicaid expenditures were mostly avoided in the state budget due to relief provided by federal stimulus measures issued in response to the COVID-19 pandemic.
Governor Andrew Cuomo’s original budget proposal sought to remove the cap on expenditures counties had to make towards increasing Medicaid costs, a move that would’ve cost Tompkins County an estimated $1.54 million according to figures provided by County Administrator Jason Molino last month. The Governor’s proposal was meant to close a $6.1 billion budget shortfall, mostly due to skyrocketing costs of Medicaid programs across the state, but much of the original plan evaporated after one of the federal stimulus packages included up to $6.7 billion in emergency contributions to the program.
“I strongly opposed that shift since it would inevitably fall as a heavier burden on the county property taxpayer and so I was pleased that the increased federal Medicaid funding was contingent upon the state not shifting any Medicaid costs to localities,” Senator Tom O’Mara (R-Big Flats) told the Ithaca Voice.
The plan as it exists, however, comes with a great deal of uncertainty. The $6.7 billion in federal contributions are dispersed over the period of, at most, a year — provided the national health emergency remains in place and the state doesn’t make any changes to the Medicaid program. At the same time, legislation passed in the budget allows Cuomo to change certain fiscal measures mostly with unilateral control throughout the fiscal year.
Molino told the Ithaca Voice the state’s congressional delegation has reassured county leaders that a portion of the federal funds is legally required to go to counties directly, but there’s still a high degree of uncertainty.
“We don’t know any of those elements so it’s very difficult if not near impossible to try to predict this year’s outcomes,” Molino said. “At the same point in time how does that feed into next year and how is next year going to play out?”
Though the hit wasn’t as large as expected, counties are facing several new required fiscal contributions to the state including part of sales tax revenues which will be withheld to cover a funding pool for fiscally distressed hospitals and nursing homes. According to estimates from the New York Association of Counties, it could cost Tompkins County about $332,000 in lost revenue.
Molino said the challenges in estimating and projecting the budget are “unprecedented” due to what will likely be fluctuations in major revenue streams like sales tax which policymakers can’t even begin to evaluate until data becomes available. He said that the process will be a “month to month” series of updates.
A spokesperson for Assemblywoman Barbara Lifton (D-Ithaca) didn’t respond to repeated requests for comment. She previously told the Ithaca Voice that she was in favor of increasing taxes on high-income earners to offset the Medicaid shortfalls. No new direct income taxes were levied as part of the plan.