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Meeting the Challenges of Health Care in New York State

With the Affordable Care Act in short view providing medical coverage on a federal level to all residents of this nation, I have wondered, as an employee of the Erie County Department of Social Services in Buffalo, NY, how we have been able to provide health care programs for the residents of this state. There can be much confusion as to the systemic flow of funds into the region and how it is spent in the community.

New York State’s Medicaid program is the largest in the country. In fiscal year 2010, New York’s $2,700 per resident Medicaid spending exceeded per capita Medicaid spending in the rest of the country by more than $1,500. I’m sure many individuals who do not reside here wonder why the cost is so exorbitant. Part of the answer can be found in New York State’s Constitution, Article XVII, Section 1, paragraph 3 stating: “The protection and promotion of the health of the inhabitants of the state are matters of public concern and provision therefore shall be made by the state and by such of its subdivisions and in such manner, and by such means as the legislature shall from time to time determine,” (New. Adopted by Constitutional Convention of 1938 and approved by vote of the people November 8, 1938). In other words, it’s a matter of state concern that all residents of New York State are provided for.

New York State has been providing services for several decades to individuals and families without a residency requirement. In regards to our public healthcare system, established in 1966, it is second to none.

The statistics are as follows with consideration to health care coverage in Erie County:

Cases Individuals

Medicaid: (Cases) 63,103; (Individuals) 98,012

Medicaid/SSI: (Cases) 29,995; (Individuals) 30,001

Family Health Plus: (Cases) 10,574; (Individuals) 27,872

(F. DeCarlo)

I was fortunate to speak with Mr. Frank DeCarlo, Assistant Commissioner of the Erie County Department of Social Services and Ms. Shaun Hughes, Administrative Director III, who oversees Erie County’s Medicaid and Managed Care Programs. Both Mr. DeCarlo and Ms. Hughes believe that the programs that are required by the state, serviced by local governments, are comprehensive and meet the needs of our community. From Long Term Home Health Care to Medicaid Utilization Review (MUR) to Community Alternative Systems Agency (CASA) to the Nursing Home Division, New York State’s Medicaid programs are able to connect with individuals and families with specific health needs. Certain products, like Child Health Plus and Family Health Plus are administered by health insurance companies. “Independent Health, Fidelis, Community Blue and Univera are four managed care companies that Erie County works with to provide affordable health insurance to families and children,” Ms. Hughes stated. These programs, depending on eligibility (percentage of poverty level), assists families, children and individuals who do not have health insurance offered through their employer or cannot afford it directly.

As for the cost, New York State allocates funds to Erie County towards the cost of these programs to service the county. “The funds are used for contracts, staff, buildings expenses, etc.” per Mr. DeCarlo. “It’s a very generous allocation.” In 2003, Medicaid accounted for 73 percent of local property taxes. In addition to raising property taxes, counties responded to rising Medicaid costs by increasing local sales taxes and cutting local jobs and programs. Counties turned to Albany for relief from their local share obligations, and in 2004 legislation requiring a State takeover of the local share of Family Health Plus was enacted. More comprehensive assistance was provided in 2005, when the State Legislature passed sweeping new legislation reallocating financial responsibility for the State’s Medicaid program. County officials enthusiastically endorsed the Medicaid cap legislation. Although it does not entirely remove Medicaid costs from local budgets, it substantially reduces the growth of local Medicaid costs. An approximate 1-2 percent per year per county cost, assuming the continuation of historical growth patterns.

This is just the tip of the iceberg as to the comprehensive and progressive ways in which New York State has been meeting the challenges of providing cost conscience and above standard healthcare for its residents.

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Author: Jill Bach is the principal clerk at the Erie County Department of Social Services. She can be reached at [email protected]

Image courtesy of http://thinkprogress.org/health/2012/10/26/1095881/medicaid-safety-net-hospitals-billions/?mobile=nc.

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