Part III of the series “The State’s Quiet Usury: How Albany Drains the Counties”
A COLUMN by Clayton “Tiger” Hulin, R.N.
If you want to see how quiet theft works, do not look in the night. Look in a budget, specifically the Medicaid line.
New York is one of the only states in the nation that makes its counties pay for a share of the state’s Medicaid costs, a relic from the 1960s that never went away. Every year, Albany applauds itself for “fully funding” social programs while quietly passing the bill down the line to the people least able to shoulder it.
That line item is the largest single expense in most county budgets. Bigger than roads. Bigger than public safety. Bigger than any local program we actually control.
How It Really Works
Here’s the game. The state collects federal and state Medicaid funds, then tells each county what percentage it must contribute. Counties have no say in the benefit levels, the eligibility criteria, or the spending rules, but they have to pay for it anyway.
Allegany County’s share runs into the tens of millions every year. Cattaraugus County’s even more. Every time Albany raises Medicaid spending, counties either raise property taxes or cut something else to balance the books.
When counties complain, the state pats them on the head and announces a “Medicaid relief plan,” which is just Albany using new federal money to replace part of what counties already pay. No relief, just recycled credit.
It is a shell game dressed as compassion.
The Mandate That Never Ends
The cruelest part is that local leaders cannot fix it. Medicaid is a state mandate. Counties are like cashiers forced to ring up Albany’s tab.
In a fair system, the state would fund its own social programs. Counties would handle local services, the ones we can see and touch. Instead, we send millions to Albany every year, and the state turns around and says, “See how much we have invested in health care.”
That is not investment. That is laundering through geography.
The Ripple Effect
Every dollar sent north to cover Medicaid is a dollar not spent fixing a bridge, hiring a nurse, or keeping a sheriff’s cruiser on the road.
When Albany says “Medicaid expansion,” what it means in places like Belmont or Little Valley is “property tax increase.”
The numbers do not lie. New York’s property taxes are among the highest in the nation, and this mandate is the reason. No amount of ribbon-cuttings can hide that arithmetic.
What Counties Could Do
Counties should start publishing a Medicaid Transparency Statement in every budget summary, a simple line that tells the truth.
“X percent of your county property tax dollars go directly to fund state-mandated Medicaid expenses.”
Print it on the tax bill. Post it at the courthouse. Let the voters see who is paying for whom.
When the public understands the math, Albany’s excuses will not survive daylight, and legislators will not be forced to wear an egg on their face from an egg thrown a full state away.
A Matter of Dignity
Health care for the poor is a moral obligation. But forcing rural counties to fund a state program is not morality; it is arithmetic fraud dressed in virtue.
If the state believes in universal care, it should pay for it universally, not carve the cost into the backroads of counties that can barely keep the lights on.
A Word of Thanks
To the caseworkers, nurses, and social service staff who make the system function, thank you. You carry the load of both compassion and bureaucracy every single day. This is not about you. It is about a structure that hides behind your good work to justify a broken contract.
A Closing Word
The Medicaid mandate is the quietest tax in New York. It does not show up on your ballot, but it drains your paycheck just the same.
Albany built the program. Counties keep it alive.
And someday soon, they ought to send the state a bill marked “past due.”
The State’s Quiet Usury — Part III: The Medicaid Mirage | © Tiger 2025 | For The Wellsville Sun
