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County Tight-Roping Health-Care Dilemmas



Only days after the Chautauqua County Legislature unanimously backed a motion urging New York state approval for a new Brooks-TLC Hospital System in the Dunkirk-Fredonia area, Executive PJ Wendel headed to Albany for a New York State Association of Counties meeting that had a different agenda. It dealt with a Medicaid proposal that could mean $625 millions less for counties across the state this year.

“The governor is irresponsibly choosing to raid local funds instead of getting state spending under control,” the state Association of Counties says on its web site. Locally, the loss of funding could be about $4.3 million this year.

Lawmakers — during the same meeting they backed a new north county hospital on Feb. 23 — also supported the resolution opposing the plan in Gov. Kathy Hochul’s budget to shift costs to local taxpayers to pay for Medicaid. Before the vote, Legislator Marty Proctor, R-Mina, expressed his support for the motion. “Federal Medicaid assistance money is allocated by the federal government to all our counties but given to New York state as a pass-through to all our counties. Our governor, in her budget, has proposed to keep these funds,” he said.

Medicaid provides health coverage to more than 84 million Americans, especially eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. It is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. Locally, 44,963 rely on the program. That’s about 36% of the residents who live here.

Budget information indicates county Medicaid expenses — in the 2023 portion of the Social Services budget — total more than $28 million. That’s $2 million less — a 7% decrease — than what the county reported in 2016.

Yet the county’s total spending in its budget from 2019 to 2023 has increased from $232 million to $274 million — or 15% over five years.

But resistance to the governor’s plan — and the added criticism — is one more layer of anxiety for a hospital that is already living on borrowed time. Brooks-TLC, which desperately awaits approval by the state to release some $74 million set aside for a new facility, is coming up on a major deadline as the month of March begins: construction season.

That also coincides with one more important date. The last extension for Brooks-TLC to purchase the land at the former Cornell Cooperative Extension site, where the new hospital will be built, was changed to June 1.

Wendel’s political roulette, spurred mainly by large Republican sentiment in upstate, does nothing to help the Brooks-TLC situation. State funds are under the control of Democrats who have not been kind lately to Chautauqua County.

In her visit to UB on Monday, Hochul announced $3.2 million in aid for schools. In addition, she announced a paltry $228,000 for Jamestown Community College. Other funding went to road and bridge improvements for the state Department of Transportation that impact the region. No other initiatives for the county stood out.

During her stop to Dunkirk in January, when she announced $10 million for the city as part of the Downtown Revitalization Initiative, she was careful in addressing when funds set aside in 2016 and 2017 would be available for the new hospital build.

“This is very important to our health team and they’re involved in conversations about keeping it viable,” she said. “It’s important. It’s a job creator, but also you need a place to go get care when you’re sick.”

Those comments seem hollow after another county project received significant funding three weeks later. On Feb. 15, Hochul’s office announced $658 million to support 127 health-care projects. One included $30 million for an important capital improvement to expand and consolidate surgical services at UPMC Chautauqua in Jamestown.

Since 2018, Brooks-TLC has been hoping a new state-of-the-art building would bring some fiscal stability. Over a four-year span, the institution ran deficits that totaled $55 million. During that same time period, New York state — through Democratic leadership in former Gov. Andrew Cuomo or Hochul — subsidized operations at the struggling and antiquated Dunkirk location through $40 million in funding.

As time ticks toward spring, a future becomes even cloudier. As the county fights for $4.3 million — or 1.5% of its total budget — with a governor that pulls the strings, there is a different crisis facing one health-care provider that has received consistent support to remain afloat from Albany.

Lakeshore Hospital in Irving closed during Wendel’s second month as executive. He doesn’t want to be at the helm if another provider is forced to do the same.

John D’Agostino is the editor of The Post-Journal, OBSERVER and Times Observer in Warren, Pa. Send comments to or call 716-366-3000, ext. 253.

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