WHEREAS, the Medicaid program is financed jointly by the State, the Federal government, and local governments; and

WHEREAS, the New York State fiscal year 2024 adopted budget ends the Affordable Care Act (ACA) enhanced Federal Medical Assistance Percentage (eFMAP) federal pass-thru to counties and New York City; and

WHEREAS, the State is proposing to keep all of these federal savings going forward and plans to use them to cover further expansions of Medicaid eligibility and benefits and to increase payments to health care providers; and

WHEREAS, this change will effectively reverse the cap set on the County’s local share of Medicaid; and

WHEREAS, this funding has been critical to counties’ ability to hold property taxes in check by limiting the local financial burden of Medicaid; and

WHEREAS, the elimination of this ACA eFMAP federal pass-thru will require the 57 counties to spend at least $280 million more in SFY 2024, and approximately $1 billion when New York City is included; and

WHEREAS, the SFY 2024 costs to counties and New York City are scheduled to grow by 30 percent by SFY 2027; and

WHEREAS, it is the strong view of NYSAC that congress intended these federal savings to be shared with counties proportional to the amount they contributed toward the nonfederal Medicaid match; and

WHEREAS, starting in SFY 2014, New York began sharing these federal ACA savings directly with counties; and

WHEREAS, the savings for a year were provided by lowering the weekly payments each county and NYC make to the state to support the State’s Medicaid program, and through February 1, 2023, the state continues to share the federal savings from the ACA eFMAP with the 57 counties and NYC; and

WHEREAS, the intercept is effective April 1, 2023; and

          WHEREAS, the County’s Operating Budget was adopted December 5, 2022, prior to the State’s interception of such funding; and

          WHEREAS, the County’s estimated annual cost in response to this impact is $4,619,504.00; and

WHEREAS, there is a 25% phase out in State Fiscal Year 2024, or $1,154,876 for Ulster County; and

WHEREAS, upon closing of the 2021 financials, Ulster County ended with an unrestricted fund balance of over $94 million, or 31% of total General Fund expenditures and operating transfers out; and

WHEREAS, a surplus is anticipated for the year ended December 31, 2022; and

WHEREAS, Ulster County’s adopted Fund Balance Policy requires unrestricted fund balance within the General Fund to be between 15% and 20% of current General Fund operating expenditures; now, therefore be it

RESOLVED, that the 2023 Ulster County Budget is hereby amended as follows for the purpose of providing funding for the County’s share of Medicaid in response to the State’s adopted Fiscal Year 2024 Budget:

                                                       INCREASE                          AMOUNT                                  

AA.6102.2715-4600.4660                  Misc. Contractual                   $769,917.00

(App. #)                                           Exp Other - MMIS                                                                                                                                  

AA.9900.9900-3700.9990                  Appropriated Fund Balance      $769,917.00 

(Rev. #),                                                                                       

and move its adoption.

ADOPTED BY THE FOLLOWING VOTE:

AYES:                      NOES:    

Passed Committee: Ways and Means on ­­­­­­­­­­­_______________.

FINANCIAL IMPACT:

$769,917.00 – 2023 COUNTY APPROPRIATIONS

$769,917.00 – 2023 APPROPRIATED FUND BALANCE