By Elaine Phillips
There’s a fiscal crisis unfolding in New York—and it’s emptying the pockets of Nassau County residents.
Medicaid is consuming a staggering 41.8% of the state’s $252 billion budget, amounting to $105.4 billion annually. That’s not a typo! More than two of every five dollars spent by New York State now funds a Medicaid program that’s growing far faster than our population or our ability to pay for it. And in Nassau, we’re footing an unfair share of that bill because of decisions made in Albany and costs driven by New York City’s reckless policies.
In 2025 alone, Nassau will be forced by New York State to spend $254 million of local taxpayer dollars on Medicaid. That’s money coming directly from your property taxes. It’s roughly $544 per household—the equivalent of a monthly grocery bill, car payment, or several utility bills. Simply put, you’re subsidizing a Medicaid system that lacks transparency, is riddled with budget gimmicks, and is expanding with no end in sight.
Since 2010, the cost of Medicaid has increased by a whopping 300%, yet the number of people enrolled has increased by 50%. The cost burden has exploded, driven by a mix of unchecked reimbursements, benefit expansions, and Albany’s refusal to implement meaningful cost controls.
Despite having fewer residents than either Texas or Florida, New York spends more on Medicaid than both states combined — highlighting just how outsized and unsustainable Medicaid has become.
New York’s Medicaid program now covers more than 1 in 3 New Yorkers. Add in the Essential Plan, and nearly 43% of the state’s population is on a public health plan. When almost half the population is on government-funded health care, and a shrinking base of taxpayers are footing the bill due to a mass exodus for southern states, the math no longer works. Even the State Comptroller has stated that this growth is unsustainable. 1
New York continues to push the envelope. As of 2024, the state now provides full Medicaid benefits — including long-term care—to undocumented immigrants aged 65+. That’s a benefit most states don’t offer even to legal residents unless they meet strict criteria. Yet, Albany lawmakers have chosen to saddle you with this enormous new cost — spending your tax dollars without any public debate.
New York’s Medicaid costs dwarf those of nearly every other state. Only California — more than twice our size — spends more. Our enrollment is second-highest in the nation. But New York offers more generous benefits than most states, pays providers more per service, and cover more categories of care. That might make Albany lawmakers feel good, but it puts Nassau taxpayers in a financial chokehold.
Let’s be clear: Nassau isn’t the driver of excessive spending. Explosive costs are coming from New York City (nearly 60% of enrollees statewide) — expanded eligibility
and dense populations result in soaring Medicaid disbursements. Yet, New York State expects counties like Nassau to contribute just the same—without any local control, without the proportional benefit, and without the ability to say “enough.”
A safety net for those in need is essential, but New York needs serious Medicaid reform. That means restoring fiscal discipline, increasing transparency, stopping benefits for illegal migrants, and pursuing efficiencies
that other states have already achieved. It means rejecting unfunded mandates and giving counties a fair deal. And above all, it means respecting all of New York’s taxpayers.
In Nassau County, we’ve done the hard work of holding the line on the County portion of property taxes for the past 3 years and budgeting responsibly, while providing top-tier services and properly funding police. Albany continues to make our job more difficult as they use Nassau taxpayers as a piggy bank.
It’s time for the State to protect all New Yorkers from a fiscal crisis of its own making. Nassau families deserve better.
Elaine Phillips is the Nassau County Comptroller.
1 OSC February 2025: Report on the State Fiscal Year 2025-2026