Opinion

NY’s Medicaid hangover

In “Field of Dreams” an Iowa farmer seemed to prove that if you build it — in his case, a baseball diamond on one of his cornfields — they will come.

The New York version of this story is Medicaid. And its ending is not nearly as uplifting as the Kevin Costner film version. Because we have built this program to grow and grow, waste and fraud will come with it.

We had a hint of this in a recent audit from the Department of Health and Human Services. The audit identified an “extremely high” incidence of error in billing in the Family-Based Treatment Rehabilitation Services program for mentally ill young people. As a result, the state has overcharged the federal government, so the latter is now demanding New York return $27.4 million in reimbursement fees.

It’s true that $27.4 million is a drop in the bucket given the billions the state spends on Medicaid. But it’s also true that HHS is not the only one raising questions about how New York is spending its Medicaid money. A bipartisan report by the US House Oversight and Government Reform Committee released last month was particularly scathing about putting the state’s spending practices into depressing perspective.

“While misuse of Medicaid funds is a problem nationwide,” the report says, “New York state’s longstanding attitude of ‘if it moves, Medicaid it’ has resulted in the state inappropriately spending tens of billions of federal tax dollars over the past few decades. Although the Committee’s oversight efforts during the last Congress focused on problems in the Medicaid program across the country, time and time again, the committee discovered that the worst abuses of the program consistently occurred in New York.”

The report rightly notes that the mismanagement, waste and fraud predate the Cuomo administration, that the governor has imposed some reforms to hem in abuses — and that the problems with ineffective oversight occur at both the federal and state level.

But as the feds and the state haggle over who owes what to whom, it would be helpful to recognize the biggest problem with Medicaid: its size and growth. Next year, New York projects the state will spend $56 billion on Medicaid — the most of any state in the nation. And it’s only going to get larger.

That’s the point. The real reform of Medicaid is one that begins by shrinking it.