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Counties fight Hochul's Medicaid 'cost-shift' proposal

Lights shine from within a large stone building at night.
Matt Ryan
New York NOW
The bright lights within the New York State Capitol building can be seen at nighttime in Albany, N.Y.

State budget negotiations are entering their final two weeks, and a battle could be brewing over who should cover the cost of Medicaid.  Onondaga County is among those bristling at Gov. Kathy Hochul's proposal to share more of those costs with county governments. The New York Association of Counties has been hammering Hochul over what the the group is calling her $625 million "cost-shift" plan. The association said counties would be forced to raise taxes or cut services to cover their share.

Onondaga County Executive Ryan McMahon said the governor's proposal is unprecedented because it reverses progress made in past years when the state capped the cost to counties. He said the state is already getting plenty of Medicaid aid from the federal government, and doesn’t pass all of it along to counties. McMahon said he feels the state owes the county a reconciliation payment of $25 million accrued over four years.

"We thought we were going to get $25 million, and we could invest it in more things like housing," McMahon said. "But, instead, what we got was...let alone are we not giving you the money we owe you, we're going to try to intercept the money the federal government gives to us to give to you."

McMahon said that intercepted money amounts to $14 million for this year alone. He said that number is exponentially much higher for larger counties and New York City.

Assemblymember Bill Magnarelli, a Democrat representing the towns of Geddes and Van Buren and parts of the city of Syracuse, said local governments seem to forget that the state has added more money for health care, transportation and education. He saidcounties are being "very unfair" in their characterization.

"We put more money into hospitals over the last few years, especially during COVID. But we don't hear anything about that," Magnarelli said. "We don't hear about the monies that have come into the county coffers, the city coffers and the school district coffers over the last three or four years from the federal government, from the state government. Nobody's talking about that. They only talk about that they may have to pay more for this one program."

It turns out both chambers of the New York State Legislature rejected Hochul’s Medicaid cost-shift plan in their one-house budgets released last week. But it’s not clear if that will be the end of the debate as budget talks continue with a looming deadline of March 31.

Scott Willis covers politics, local government, transportation, and arts and culture for WAER. He came to Syracuse from Detroit in 2001, where he began his career in radio as an intern and freelance reporter. Scott is honored and privileged to bring the day’s news and in-depth feature reporting to WAER’s dedicated and generous listeners. You can find him on twitter @swillisWAER and email him at