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Medicaid is a train wreck about to happen

As the commissioners of our respective Departments of Social Services for Nassau and Suffolk counties, we manage a number of poverty assistance programs designed for those who can't work, those who can't find work and those who can't find work with sufficient earnings to support a family on Long Island. We and our counterparts statewide should no longer address vital social service programs and their solutions along artificial county boundary lines, as our distressed economy has in turn created distress for increasing numbers of New Yorkers, regardless of the county in which they live.

All social service assistance programs have mandated eligibility requirements, including citizenship, earnings and resources, which ensure proper benefits reach those in need. These temporary assistance programs, often referred to as "safety net" services, are in fact supported by the taxpayers, who pay a significant portion of their gross earnings in property, sales and income taxes. While so many residents of all the counties feel the burden of living in one of the most expensive and highly taxed states in the nation, it is our experience that most never complain when their tax dollars are being carefully managed and used to feed, clothe, shelter and provide for the health care of the poor, most of whom are children.

Real concern arises now with the Medicaid program, most of whose enrolled recipients are honest people with documented needs. However, for those recipients who try to cheat the Medicaid system in order to fraudulently obtain services, each of our departments has special investigators who effectively manage to track down and prosecute cheaters to the fullest extent of the law. We are diligent in our pursuit of fraud, because it hurts those truly in need and strains the public's generous spirit to provide for our most vulnerable populations.

Both Nassau and Suffolk counties participate in the State's Provider Fraud Demonstration Project, designed to eliminate Medicaid provider fraud. Over the last several years, the state and our counties have redoubled efforts to identify fraud and abuse. Suffolk and Nassau Medicaid Prescription Fraud Projects work in cooperation with our county Police Departments and District Attorneys' Offices to prosecute opiate prescription fraud and halt the use of government funds to pay for addiction and diversion.

Despite aggressive and effective anti-fraud initiatives, we still find alarming developments on the state level with Medicaid, leading this vital program on an unsustainable path. One example is the recent change in the New York State Department of Health's criteria for Medicaid eligibility, which now allows mere attestations in place of documentation. Another example is the state's dropping any means test for Medicaid. This means the Department of Social Services can consider an applicant's income, but not what he owns. These changes alone encourage fraud.

The beneficiaries of Medicaid services will ultimately shoulder the burden when these programs inevitably become unsustainable in their current form, causing service reductions, and in some cases elimination of program benefits. Most recently, Arizona has decided to deny payments for certain types of life-saving medical interventions. Should this mark the beginning of a national trend, we will never be able to estimate the number of lives ended prematurely because the system went out of fiscal control.

New York State has traditionally stood as a leader in the area of health and human services, and Nassau and Suffolk and their sister counties have certainly done their share to promote that reputation. According to the most recent federal data, New York spends more per capita ($2,360) on Medicaid than any other state in the country, and more than twice the national average ($1,077). Absent more common-sense fiscal controls, the destiny of Medicaid and those it reaches is nothing less than alarming.

Nassau County currently has 128,411 individuals participating in the Medicaid program, up 88 percent since 2000, representing 10 percent of Nassau's total population; Suffolk County has 166,080 individuals enrolled in Medicaid, up 140 percent over 2000 enrollment and currently representing 11 percent of Suffolk's population.

Medicaid is the largest mandated item in every county and state budget in the nation. New York State spent $53 billion on Medicaid in 2009 and, according to the New York State Association of Counties, it consumes approximately 45 percent -- and in some instances 100 percent -- of each county's real property tax levy. Suffolk's Medicaid share is almost four times the actual property tax levy. In Erie County, Medicaid spending accounts for 95 percent of the tax levy.

With declining state revenue, rising enrollments and increased medical costs, Medicaid is, quite candidly, a train wreck about to happen. New York is one of the few remaining states still requiring localities to pay a substantial portion of the costs of Medicaid -- and in New York that means local property taxpayers are on the hook for more than several billion dollars annually. Most disturbing is the area for creative fraud, fostered by a carelessly loose application process and managed by unelected bureaucracies. In our collective judgment, far too much discretion in Medicaid decisions and policy-making is left to unelected officials who remain unaccountable to the taxpayers who must ultimately foot the bills.

We close with noting that the pending state takeover of Medicaid administration costs is relatively insignificant, accounting only for 2 percent to 3 percent of the state's total annual Medicaid cost of $53 billion. Further, when the state assumes control of Medicaid administration, it will in fact create a fiscal vacuum in most social services departments due to lost reimbursements that local dollars will have to fill. This unnecessarily adds to the daunting, fiscal challenges that Suffolk County Executive Steve Levy and Nassau County Executive Ed Mangano have been meeting with creativity and foresight. Their counterparts statewide will contend with this added, hidden cost as well. For real reform and preservation of a truly worthy program that serves as a last-hope, life-saving safety net for the poor, the state takeover of Medicaid administration must be accompanied by the state's assuming responsibility for the program's partially or totally unfunded mandates and costs. With good cause, the taxpayers have said, enough is enough!


Gregory J. Blass is commissioner of the Suffolk County Department of Social Services and John E. Imhof is commissioner of the Nassau County Department of Social Services.

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