What Is Medicaid


Medicaid is a joint federal – state health insurance program that assists those persons with low income and limited resources. In New York State, the State government requires county governments to administer and provide Medicaid services and to pay a portion of the cost of Medicaid. Until 2006, counties generally paid 25% of the total cost of Medicaid, the State paid 25%, and the federal government paid 50%. This was not an exact ratio of county share expense, as certain adjustments to the funding formula, including in long term care and nursing home expense starting in 2004 reduced county share expense.

For example, long term care expenses, a very large portion of Erie County’s Medicaid costs, began moving out of the county share in 2004, thus lowering Erie County’s overall share of the expense. The Nursing Home category and Home Health services category made up 41% of the total Medicaid program expenses for Erie County in 2011. As the expense for these services was moved from the county share, the percentage of the county share correspondingly reduced over time. There are also populations for which Erie County is responsible for a lower share of the cost of Medicaid, such as Native Americans.

Presently, due to these various funding adjustments and also due to the State’s “Medicaid Cap” process, the Erie County share of Medicaid expense is approximately 15%. That said, the County’s annual expense for Medicaid-MMIS is still the single-largest appropriation account in our operating budget. . These statistics and data do not include any intergovernmental transfer (“IGT”) payments required under federal law and regulations to be made by the County for the benefit of Erie County Medical Center Corporation.

Medicaid became law in 1965. It is often confused with Medicare. Medicare is a federal health insurance program that helps the elderly and disabled. It is possible to qualify for both programs. In that case, Medicaid typically pays the Medicare coinsurance and deductibles. Medicaid has a core of services mandated by the Federal government and optional services the states can cover or provide if they so choose. New York State covers nearly all the optional services for Medicaid.

Medicaid services can be provided in one of three ways – Fee for Service, Rate, and Managed Care. Fee for Service is a process where Medicaid providers are paid a fee for the service provided. The fee is based upon a set maximum price for units of service. Rate providers are paid a threshold rate based upon cost report data submitted annually to the New York State Department of Health. There are other reimbursement formulas for Rate providers and the rate can vary daily, monthly or annually. In Managed Care, Managed Care Organizations (“MCO”) are paid a monthly capitation payment for each enrolled member to coordinate the provision, quality and cost of care for these enrolled members.

Below are some key Medicaid data points for selected years and ending with 2017.  More detail on Medicaid, Medicaid expenditures within Erie County and Erie County Medicaid recipients can be found in the 2017 Medicaid Report generated by this office.   See the section maked "Latest News".




The Medicaid Drugs in Erie County with the Most Filled Prescriptions are:
  2012 2013 2014 2015 2016
1 Hydrocodone-Acetaminophen Hydrocodone-Acetaminophen Hydrocodone-Acetaminophen Hydrocodone-Acetaminophen Ibuprofen
2 Ibuprofen Ibuprofen Ibuprofen Ibuprofen Omeprazole
3 Omeprazole Omeprazole Omeprazole Omeprazole Hydrocodone-Acetaminophen
4 Lisinopril Lisinopril Lisinopril Lisinopril Atorvastatin Calcium
5 Aspirin Aspirin Metformin HCL Atorvastatin Calcium Lisinopril
6 Ventolin HFA Ventolin HFA Ventolin HFA Ventolin HFA Metformin HCL
7 Metformin HCL Metformin HCL Atorvastatin Calcium Metformin HCL Ventolin HFA
8 Amoxicillin Amlodipine Besylate Amlodipine Besylate Amlodipine Besylate Amlodipine Besylate
9 Loratdine Levothyroxine Sodium Levothyroxine Sodium Levothyroxine Sodium Levothyroxine Sodium
10 Amlodipine Besylate Amoxicillin Aspirin Gabapentin Gabapentin
11 Levothyroxine Sodium Loratdine Amoxicillin Aspirin Amoxicillin
12 Clonazepam Atorvastatin Calcium Gabapentin Amoxicillin Aspirin
All Prescriptions Filled                                  2,232,649                                  2,418,830                                  2,644,863                                  3,036,661                                  3,190,990
Just Above Scripts Filled                                     467,601                                     489,760                                     542,888                                     646,910                                     676,377
Percent of Total 20.94% 20.25% 20.53% 21.30% 21.20%
Year 2012 2013 2014 2015 2016
Total Medicaid Enrollees          
                                    221,753                                     229,364                                     259,421                                     286,145                                     282,844
Total of All Prescriptions Filled in Year          
                                 2,232,649                                  2,418,830                                  2,644,863                                  3,036,661                                  3,190,990
Hydrocodone Prescriptions                                       77,027                                       69,246                                       68,807                                       77,981                                       68,154
Percentage of Hydrocodone Prescriptions to all Medicaid Prescriptions 3.45% 2.86% 2.60% 2.57% 2.14%


Drug Name Commonly prescribed for:
Amlodipine Besylate High blood pressure treatment
Amoxicillin Infection treatment (Antibiotic) 
Aspirin Over the counter pain reliever
Atorvastatin Calcium Elevated cholesterol treatment
Clonazepam Epilepsy treatment and treatment for bipolar disease and panic attacks
Gabapentin Anti-epileptic medication and treatment for some kinds of nerve pain
Hydrochlorothiazide Treatment for high blood pressure, also osteoporosis and is a diuretic
Hydrocodone-Acetaminophen Treatment for moderate to severe pain
Ibuprofen Over the counter pain reliever
Levothyroxine Sodium Treatment for thyroid deficiency
Lisinopril High blood pressure treatment
Loratadine Treatment for allergies
Metformin HCL Treatment for type two diabetes or pre-diabetics
Omeprazole Treatment for acid reflux
Ventolin HFA Treatment for asthma or allergies
Vitamin D Addresses bone loss and cognitive impairment



Phone: (716) 858-4639
Fax: (716) 858-4629

Erie County Medicaid Inspector General
Edward A Rath County Office Building
95 Franklin Street, Room 802
Buffalo, New York 14202