TOMPKINS COUNTY, N.Y.—County officials have published a series of statements calling on Gov. Kathy Hochul to avoid shifting hundreds of millions in Medicaid expenses onto county governments in her new state budget.

According to government officials, Hochul plans to shift $625 million in Medicaid costs from the state government in 2024, making those costs the responsibility of county governments to cover. Such a move could cost Tompkins County $600,000 this year and $1.5 million next year in its budget. Estimates in Tompkins County state that it would be “equal to a 3 percent increase in the local property tax levy.”

“If the State’s goals are to increase affordability and provide robust services to those in need this is an unwise proposal,” said Lisa Holmes, Tompkins County Administrator. “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. 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.”

The state budget is still being negotiated, with a March 31 deadline for a vote.

According to Holmes and other Tompkins County officials, the issue stems from Hochul’s proposal to use federal eFMAP funds, which are partially intended for distribution to New York county governments to offset Medicaid costs under the Affordable Care Act. This year, though, the state government has proposed keeping the eFMAP distributions for usage in the state budget instead of sending it on to counties.

Several counties across the state have objected to the proposal, as it was put forth in Hochul’s state budget. Republican Congressman Marc Molinaro, who represents New York’s 19th Congressional District including Tompkins County, has proposed a bill in the U.S. House of Representatives (along with two other New York Republicans) to prevent the federal money from being kept at the state level instead of distributed to counties.

The New York State Association of Counties has also vocally opposed the proposal.

Tompkins County Legislature members Shawna Black and Deborah Dawson both criticized the plan, with Black calling it “unsustainable” and that it would force the county to either pass the cost on or “to cut services that our public depends on.”

“It’s imperative that the Governor change course on this. Counties would be left picking up the tab while the State pockets billions,” said Dawson, who leads the Budget, Capital, and Personnel Committee for the county. “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.”

Matt Butler

Matt Butler is the Managing Editor at the Ithaca Voice. He can be reached by email at