New York State and Washington, D.C. appear to be locked in a potentially dangerous tug-of-war regarding the cost of the Medicaid health insurance program, which guarantees affordable health care and mental health services to poor families and individuals in need. The president and Congress are proposing to cut Medicaid funding by $14 million over the next five years. In New York, Governor Pataki and Legislative leaders are locked in negotiations to decide how much New York can continue to spend on Medicaid when local municipalities and counties like Nassau and Suffolk are demanding Medicaid reform and relief from continued state spending mandates. Regardless of where the Medicaid battle is taking place, one thing is for certain, millions of poor families, single parents, frail elderly, disabled, mentally ill, and underemployed people are caught in the middle.

There is nothing fundamentally wrong with trying to cap Medicaid spending, or taking appropriate steps to curb potential Medicaid abuse. Certainly, recent events in Nassau County clearly illustrate that the Medicaid system in New York is not without flaws. Like any public program that relies on cash dispersements as opposed to a voucher system, there is going to be abuse. But, before Congress or the State Legislature cuts the Medicaid program, it is important to understand just who makes up New York's poor these days. Data for 2003 describes the monthly average number of Medicaid eligible individuals to be approximately 85,000. Of this number, 5,100 are children; 5,200 are aged; and 14,000 are blind and disabled. The face of Medicaid in New York State is comprised of a diverse group of citizens.

People who have lost their jobs and subsequently their health insurance coverage are applying for Medicaid. Senior citizens who require assisted and rehabilitative care have relinquished most of their assets in order to qualify for subsidized health insurance. Many still affected by the September 11, 2001 World Trade Center attack continue to receive Disaster Relief Medicaid assistance.

The Medicaid health insurance program has afforded many of New York's most vulnerable citizens an opportunity to receive quality health, mental health and substance abuse services. The program has addressed the needs of children, poor families, the indigent, disabled, and Long Island's working poor. Reducing local government's share of costs associated with Medicaid, creating a block grant program for all of the 50 states, and capping certain costs, are all proposals that should be considered in trying to contain expenses and ensure that the Medicaid program is reaching those who need it the most. But, before politicians cut the program, it would be beneficial to understand just who will be affected and how they will be affected. Recent legislation proposed in Washington, D.C. calls for the creation of a special expert panel to study Medicaid before the entire system is overhauled. Similar to a panel convened to study our Social Security system, a Medicaid panel can carefully review eligibility criteria, state expenditures, procedural safeguards and future growth of the program.

Providing access to healthcare for all New Yorkers and all Americans in need is too critical an issue to simply just cut budgets. It requires intelligent planning, an understanding of the populations served, and compassion.