New York State spent more than $20 billion on Medicaid this fiscal year - or nearly a quarter of the total operating budget. With the state confronting a projected $10 billion deficit for next year, Gov. Andrew Cuomo has little choice but to cut back the program. The challenge will be to do that in a way that causes the least possible harm to some of the state's most vulnerable citizens.

Mr. Cuomo’s new budget seeks to reduce the state’s share of Medicaid spending from a projected $20.8 billion to about $18 billion. That would trigger a loss in federal matching funds of about $2.7 billion, draining a total of more than $5.5 billion.

In coming weeks, the governor and the Legislature will have to decide where to find that money. None of the choices are easy or pretty.

Should the state cut payments to hospitals, nursing homes, and other providers that have already taken hits in previous budgets? Should it drop hundreds of thousands of people from the rolls, as Arizona plans to do? Should New York place even more of a burden on families by whittling down the hours of home care provided to people suffering from multiple chronic illnesses or the hours of personal care to help the elderly or disabled with bathing, dressing, eating and other daily tasks?

These are difficult decisions with huge potential human costs. There is no hope of doing this right unless Albany gets beyond its pay-to-play culture.

Politicians will have to finally push back against powerful lobbies and contributors — hospitals and health care workers, drug manufacturers and patient advocacy groups. They will have to change outmoded payment formulas that keep driving costs upward and change laws that stand in the way of needed reforms.

Filed Under : Medicaid