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County Executives Unanimously Oppose Medicaid Cost Shift

Letter from all County Executives, including NYC Mayor Adams, opposing the Governor’s Medicaid cost shift.

February 10, 2023

The Honorable Kathy C. Hochul
Governor of New York State
NYS Capitol Building
Albany, NY 12224
VIA: Electronic Mail

Dear Governor Hochul:

We are writing to express our strong opposition to your executive budget proposal to stop sharing the Affordable Care Act (ACA) enhanced Federal Medical Assistance Program (eFMAP) with counties. This proposal would end the 20-year precedent of sharing federal Medicaid savings shared with local governments that contribute to the Medicaid program.

The elimination of this ACA eFMAP federal pass-through is worth nearly $300 million for the 57 counties outside New York City and between $650 to $1 billion when you include New York City. As a former county official, you can appreciate that new costs imposed on local governments eventually come out of all New Yorkers’ pockets in the form of increased property taxes which make our state less affordable place to live, work, or start a business.

Counties have been at the forefront of the COVID-19 and opioid pandemics. We have stood in partnership with your administration to advance our collective interests to address the climate crisis. And we deliver countless human services to our mutual constituency—the people of our great state.

We should be working together, for our state, for our people, to move New York forward. We share your goal of creating a more affordable state and want to remain strong partners in government. In support of this common interest, we respectfully ask that you reconsider this administrative cost shift to property taxpayers and renters and let us know that you will amend this budget proposal. On Thursday, February 2nd, through NYSCEA staff we transmitted an alternative proposal to Budget Director, Sandra Beattie for your consideration.

We are ready and committed to continuing our strong partnership with you and your administration, and we look forward to working as partners to come to a mutually agreeable conclusion.


Hon. Mark C. Poloncarz, President, NYSCEA (Erie County Executive)

Hon. Eric L. Adams (Mayor, City of New York)

Hon. Adam J. Bello (Monroe County Executive)

Hon. J. Ryan McMahon, II (Onondaga County Executive)

Hon. Daniel P. McCoy (Albany County Executive)

Hon. George Latimer (Westchester County Executive)

Hon. Paul M. Wendel, Jr. (Chautauqua County Executive)

Hon. Chris Moss (Chemung County Executive)

Hon. Anthony J. Picente, Jr. (Oneida County Executive)

Hon. Jason T. Garnar (Broome County Executive)

Hon. Matthew L. Ossenfort (Montgomery County Executive)

Hon. Steven F. McLaughlin (Rensselaer County Executive)

Hon. Jen Metzger (Ulster County Executive)

Hon. William F. X. O’Neil (Dutchess County Executive)

Hon. Steven M. Neuhaus (Orange County Executive)

Hon. Kevin M. Byrne (Putnam County Executive)

Hon. Ed J. Day (Rockland County Executive)

Hon. Bruce A. Blakeman (Nassau County Executive)

Hon. Steven C. Bellone (Suffolk County Executive)

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