On Tuesday, the state Legislature will go back to Albany for a special session, called by Gov. David Paterson, to deal with what he considers the dire fiscal picture for the state.

While Paterson is asking for $1 billion in cuts from the Legislature, the big question is, will legislators address his $505 million request for cuts in what may be the state's top fiscal challenge - Medicaid.

Medicaid is a major fiscal noose around New York's neck. Since its creation in the 1960s, New York, especially its counties, has gotten a raw deal. New York has a 50/50 deal with Washington - half the cost is paid for by the federal government and the other half paid by the Empire State, which then passes on about half of that cost to counties, like Cayuga.

One of the main problems with the program is that this is not how it works in all 50 states. As part of the compromise cut by President Lyndon Johnson, some states, especially in the South, get a bigger share of their program reimbursed by Washington. In most other states the cost is not split 50/50 between the state and counties - which, in New York, puts an immense burden on local property taxpayers - whether they support the menu of programs provided to recipients or not.

When Cayuga County Manager Wayne Allen gave his State of the County presentation this spring, the starkest slides in his PowerPoint presentation identified the escalating cost of Medicaid to Cayuga County. One slide showed it at a $12.75 million cost - 41 percent of the last year's tax levy. His next slide looked at a possible doubling of costs in eight years.

The equitability problem between Washington and New York isn't likely to be solved soon. Despite the common refrain from members of the Assembly and Senate that New York has the “Cadillac of Medicaid programs,” which if changed, could provide real cost savings in Albany and for counties, that isn't likely to change.

While it is nice to toss around in press conferences and constituent newsletters the Cadillac metaphor - such officials will rarely give specifics (the press often fails to try to pin them down). Why? While most of us may imagine that they are talking about “welfare mothers who have babies to collect benefits,” the real reason is that the majority of funds for Medicaid goes to children, the disabled and senior citizens - three groups that no politician wants to be accused of harming or voting against.

So while it is easy to identify the skyrocketing cost of Medicaid as a major culprit in New York's ongoing fiscal woes - like Social Security for Congress, real Medicaid reform is the third rail of state politics - touch it, as a politician, and you die.

Cosentino is a former mayor of Auburn and can be contacted at cozguytho@aol.com