The Medicaid cap is not just a financial change, it portends an operational change. This is personally symbolized by the return to government service of Brian Wing.
Brian's the former Commissioner of Social Services and then after re-organization, OTDA. He left a while back to work in the private sector.
Brian's returned and has joined the Health Department, specifically the Office of Medicaid Management and his charge is to figure out how to move the Medicaid functions currently administered by localities to the State. This is the administrative/operational change that needs to accompany the cap on local financial responsibility.
That's a change long overdue. The first policy paper I ever had published, Barriers to Medicaid Reform, emphasized the dispersion of policy and administrative responsibility for Medicaid between different State agencies and different levels of government. That was in 1976. Well, we're finally making progress.
Brian's job will not be fun and it's won't be headlines sexy. But it will be important. Best wishes and welcome back.