Column: State Senator Tom O'Mara

"A system that keeps failing to put taxpayers first"

ALBANY, Sept. 14, 2025 -- The latest on Medicaid spending in New York comes from the state comptroller, who came out with an audit last week that "found close to $1.2 billion in managed care premiums that were paid for members who may have resided outside of New York. Auditors found that the state Department of Health (DOH) did not properly check to confirm that Medicaid members were New York residents and waited too long to recoup improper payments."

According to state Comptroller Thomas DiNapoli, "Medicaid is a vital program and the single biggest expense in the state budget. We cannot afford any wasteful spending. If a person is enrolled in more than one state at the same time, both states may end up paying premiums to his or her managed care plans. Responsibility for preventing enrollment in more than one state lies at both the federal and state levels, and stronger coordination is needed to reduce improper payments, protect the program's integrity, and ensure New York is only paying Medicaid costs for its residents."

It simply remains outrageous and inexcusable. It's not like fiscal watchdogs inside and outside of the state Legislature haven't been banging the drum on abuse, fraud, and waste within New York's hugely expensive (and expansive) Medicaid system for as long as I can recall, yet year after year brings additional reports of ongoing fraud and waste.

Keep in mind the recent report from the federal Centers for Medicare & Medicaid Services, which I highlighted in this column not long ago, revealing that per-resident Medicaid spending in New York was nearly 25 percent higher than any other state and 77 percent above the national average.

That report pinpointed what can only be called explosive growth in Medicaid spending in New York State, especially over the past several years.

It's also worthwhile to recall here the summary of that federal report from the Albany-based Empire Center for Public Policy showing that while New York accounts for less than 6 percent of the nation's population, our state's $100 billion-plus Medicaid budget is more than 10 percent of national spending on the program. On a per-resident basis, New York's Medicaid spending was by far the highest of any state at $4,942. The national average was $2,791 per resident.

Furthermore, the findings of an Empire Center report last November, "Medicaid Overdose" (read the full report here: https://www.empirecenter.org/publications/medicaid-overdose/), remain noteworthy, including that:

--Forty-four percent of the state's population, including 60 percent of New York City residents, were enrolled in state-sponsored coverage through Medicaid or the Essential Plan as of September 2024;
--New York's 44 percent coverage rate was seven points higher than any other state, and 20 points higher than the national average;
--More than 3 million enrollees appear to have incomes above the eligibility limits for either Medicaid or the Essential Plan, based on analysis of census data;
--For every one person who stopped being counted as uninsured over the past decade, the state added more than three people to either Medicaid or the Essential Plan;
--New York offers zero-premium health coverage to residents up to 250 percent of the poverty level, the highest eligibility threshold in the United States.; and
--Over the past decade, total spending on Medicaid and the Essential Plan has nearly doubled, from $60 billion in fiscal 2015 to a projected $113 billion in fiscal 2025.

Many of us in the Legislature have long warned about this out-of-control spending which, for many years, has been the heaviest burden of all for counties and local property taxpayers. But equally troublesome are these repeated reports of abuse, fraud, and waste within the system.

From the comptroller's most recent investigation: "The audit found that DOH (Department of Health) did not start submitting NYSOH's (New York State of Health) member data for matching in the federal Public Assistance Reporting Information System (PARIS), which matches enrollment data of public assistance programs like Medicaid across all 50 states, until May 2017, nearly three years after NYSOH started. DOH did not start reviews of the NYSOH PARIS match results until two years later, in October 2019. The audit identified $1.5 billion in premium payments that were made from 2017 to 2019 for unreviewed NYSOH members. Auditors identified an additional $1.2 billion in managed care premiums paid for members that potentially resided outside New York."

DOH officials generally concurred with the findings, according to the comptroller.

Go back to the opening lines from the comptroller's audit, specifically the following: "Auditors found that the state Department of Health (DOH) did not properly check to confirm that Medicaid members were New York residents and waited too long to recoup improper payments."

Checking that Medicaid recipients are, in fact, eligible state residents before providing the benefit seems like the most fundamental step to take to ensure the program's effectiveness and integrity. The same goes for not waiting "too long to recoup improper payments."

Ensuring residency and immediately fixing mistakes seem like the very least we can do for state and local taxpayers and if it's not being done, routinely and steadfastly, it sends the wrong message to our taxpayers. It tells them that state government doesn't care. Out-of-control, wasteful Medicaid spending will never be brought back under control through a system that apparently fails, far too often, to take the first, basic steps.

We're talking about billions of taxpayer dollars being lost to apparent carelessness in a state where taxpayers, at every level, are already overtaxed and overburdened, and have been for a long time.

It needs to be stopped.

Photo in text: State Senator Tom O'Mara

Legislature Chairman

Carl Blowers, 535-6174 or 237-5469

Legislature Members:

Gary Gray, 292-9922

Jim Howell, 535-7266 or 227-1141

David M. Reed, 796-9558

Michael Lausell, 227- 9226

Phil Barnes, Watkins Glen, 481-0482

Mark Rondinaro, 398-0648

Laurence Jaynes

County Clerk: Theresa Philbin, 535-8133

Sheriff: Kevin Rumsey, 535-8222

Undersheriff: Andrew Zeigler, 535-8222

County Treasurer: Holley Sokolowski, 535-8181

District Attorney: Joseph Fazzary, 535-8383

State, Federal Officials for Schuyler County

Sen. Charles E. Schumer

United States Senate
313 Hart Senate Office Building
Washington, D.C. 20510-3201
DC Phone: 202-224-6542
DC Fax: 202-228-3027
Email Address: http://schumer.senate.gov/webform.html

Sen. Kirsten E. Gillibrand

United States Senate
478 Russell Senate Office Building
Washington, D.C. 20510
DC Phone: 202-224-4451
Website: http://gillibrand.senate.gov/

State Senator Tom O'Mara -- Chemung, Schuyler, Seneca, Steuben, Tioga, and Yates, and eastern Allegany County (towns of Alfred, Almond, Amity, Andover, Birdsall, Burns, Grove, Independence, Scio, Ward, Wellsville, and Willing).

Room 706, Legislative Office Building
Albany, NY 12247
Phone: (518) 455-2091
Fax: (518) 426-6976
www.omara.nysenate.gov

Assemblyman Phil Palmesano-- All of Schuyler and Yates, majority of Steuben, and portions of Chemung and Seneca counties.

Room 448, Legislative Office Building
Albany, NY 12248
Phone: (518) 455-5791
Fax: (518) 455-4644
Website: https://nyassembly.gov/mem/Philip-A-Palmesano/