The issue of unfunded mandates is arguably the greatest fiscal challenge we face in Erie County. The worst offense is the state’s Medicaid program. Medicaid alone accounts for nearly every dollar — or 98 percent — of property tax collected in Erie County annually. In addition to offering the federally mandated services, New York State had added numerous optional services, driving up the cost for every county. NYS’s choice to compel these services, not required by the federal government, affects how Erie County tackles all its other service costs.
During my tenure with the Erie County Legislature, my colleagues and I have repeatedly advocated to Albany to implement overdue reform. I supported legislation encouraging the state to allow individual counties to decide what optional Medicaid services it offers. Counties should individually elect what optional programs to offer, allowing counties more control over their costs. Another option I supported was NYS assuming the local share of Medicaid costs. Unfortunately those suggestions were not adopted by the state.
Because the county can’t decide what services must be offered but has to pay for them, we had to look at what we could control. Fraud is a major problem in the Medicaid system. To expose fraudulent claims, the county added two local Medicaid fraud auditors, key positions necessary to identify waste, fraud and abuse. The administration reported that these two positions will more than pay for themselves by exposing fraud and result in savings. I applaud the county executive for his commitment to rooting out Medicaid fraud and abuse.
Unfunded mandates have been on the forefront for many years, yet the governor failed to address the issue in his recent “State of the State” address or 2014 budget presentation. This leads me to believe we will again not see further change or any additional relief in the coming year or near future. We need to see real reform in NYS, as soon as possible.
At the same time, Erie County needs to diligently control its costs. To do so, governments can imitate initiatives used by successful businesses. Before Six Sigma was demolished by our current county executive, it helped to identify areas where we could control change and cost. One of the successes of Six Sigma is job training and showing employees how to start thinking about their jobs in terms of processes and small steps. As a direct result, employees identified reforms to build efficiencies into their jobs. I still support the Six Sigma model and believe there is merit for returning it to Erie County. Several states have started using Six Sigma to look at their operations and implement cost savings.
However, dealing with mandates and identifying efficiencies is only part of the solution. At the county level, we can implement reform in various other ways, including paying off old debt and reducing debt service payments; using part-time workers; and renegotiating union contracts that are similar to those in the private sector, especially in terms of health care contributions.