Published: July 14, 2008 11:15 pm      

NIAGARA COUNTY: Broader eligibility requirements drive up Medicaid costs.

Changes in state eligibility requirements are driving the Medicaid rolls higher in Niagara County.

The county’s caseload has increased by 620 since April 1, thanks to eligibility changes enacted by the state Legislature with passage of the state’s 2008-09 budget, county Social Services Commissioner Anthony Restaino said Monday.

Resource limits were increased for numerous Medicaid categories, he said, and the state ordered counties to use the Suffolk County (Long Island) public assistance standard for singles and childless couples. Niagara County’s standard, monthly income of $311 for a single person and $420 for two people, was half of the Suffolk standard, $673 for one person and $840 for two.

Restaino said the raised income ceiling caused people who would have been eligible for Family Health Plus, for which recipients may pay some costs, to now be eligible for Medicaid, which is paid for fully by the state and counties.

There is no way, currently, to say how much the additional Medicaid enrollments are costing the county, Restaino said. The county’s share of program cost is capped, he said, so the state is bearing most of the increase; the danger is that as enrollment continues to rise, the state could revisit the cap.

“If costs continue to go up, and the counties are allocated only 3 percent increases, the burden becomes greater on the state,” he said. “It’s only a matter of time before the cap is revisited.”

Restaino also alerted the county Legislature’s community services committee to hiring mandates on the horizon. The state Office of Children and Family Services has been monitoring caseloads for caseworkers in child protective services, foster care and preventive services and is recommending caseload maximums significantly lower than Niagara’s averages, he said.

Currently, child protective services caseworkers manage an average 19 cases per month, while OCFS recommends a maximum of 12. Niagara’s foster care and preventive services caseworkers handle an average 15 active cases per month, while the state is pushing for 12.

OCFS is aiming to recommend lower caseload maximums to the state Legislature next year. If they’re adopted, Niagara County would have to hire 12 more people to meet the mandate, Restaino said. In child protective services, where the county average differs most from the OCFS average, a full unit consisting of seven caseworkers, a supervisor and a clerk — would have to be added. An existing program in which the state covers caseworker salary and benefit costs expires in March 2009.

Twelve hires would be required to handle existing caseloads under OCFS mandates, according to Director of Social Services Burt Marshall. If local economic conditions worsen, more cases likely will be opened and even more caseworkers would be needed.

“As the economy goes down, our business goes up,” he said.

Contact reporter Joyce Miles at 439-9222, ext. 6245.