Who’s responsible for the NUMC?

There has been, rightfully, much discussion about the future of the Nassau University Medical Center, the only public hospital in Nassau County.

By virtue of its name, many people assume that NUMC is a Nassau County facility. In fact, it is not.

More than 20 years ago, New York state created a public benefit corporation called Nassau Health Care Corp., which in 1999 acquired ownership of the hospital, the A. Holly Patterson Extended Care Facility and clinics from the county. NHCC has owned and operated them all ever since.
NHCC has reported operating losses totaling $694 million over the past 10 years, which, combined with prior losses, led the public benefit corporation to report a total net position of negative $1.15 billion in its latest official consolidated financial statement, through Dec. 31, 2022.

NHCC continues to lose hundreds of millions of dollars a year, while state and federal funding for the hospital continues to dwindle. Over the past six years, instead of boosting financial support for the struggling medical center, state and federal funding has declined from more than $189 million in 2017 to less than $92 million in 2022. Clearly, the situation is unsustainable, and I am concerned for the county residents who rely on NUMC for care. But the county is not responsible for the hospital’s management, and has no authority to make operational changes. Responsibility for the NUMC rests with the public benefit corporation and its board, along with the state, which created NHCC and controls many billions of dollars in health care funding.

The county’s financial relationship with NUMC is limited to sharing the cost of health insurance benefits for NHCC retirees who used to work for the county, and guaranteeing $100 million in debt for the hospital, which will be paid off by 2029. These liabilities currently amount to less than 1 percent of the county’s annual operating budget, and will eventually disappear altogether.

The county also pays NHCC for specific services, including medical care, for individuals incarcerated at the Nassau County Correctional Center and youths in the custody of the Nassau County Juvenile Detention Center, and for select health, medical and screening programs for the county. In addition, the county rents space on the NUMC campus for the medical examiner’s office and for the WIC Supplemental Nutrition Program. If the county ever needs to find new resources for these services and spaces, it will be disruptive but not difficult given the abundance of high-quality health care resources in the county.

The Nassau Interim Finance Authority, which was established by the state in 2000 to oversee the county’s finances in the wake of the county’s financial distress in the late 1990s, placed NHCC under control-period conditions in light of its “weakening financial outlook” in February 2020. Since then, NIFA has paid consultants roughly $1.8 million in county taxpayer dollars to evaluate the medical center, yet improvements to the hospital’s fiscal health have failed to materialize.

NIFA often cites the hospital’s financial troubles as a reason to keep the county in a control period, but the authority’s confusion about who is responsible for NUMC is just another baseless claim NIFA uses to perpetuate the control period it imposed on the county in 2011.

For years, NIFA has approved the county’s proposed budgets and multi-year financial plans, but used wildly pessimistic and speculative projections to justify continuation of the control period. Analysis by my office has demonstrated that the authority has been consistently wrong, demonstrating an enormous gap between NIFA negative projections and the county’s actual positive fiscal results dating back to 2019.

NIFA needs to turn its attention back to the hospital and the public benefit corporation that owns and operates it. NHCC must be held accountable for the hospital’s condition, and state leadership needs to figure out how to resolve Albany’s multi-billion-dollar budget gaps without compromising the health care of Nassau’s most vulnerable residents.

The Nassau Health Care Corp. and New York state have a moral and ethical obligation to ensure continuity of services to NUMC’s patients, 65 percent of whom are on Medicaid and Medicare, and 9 percent of whom are uninsured. It’s time for NHCC and the state to figure out how they are going to stop the financial hemorrhaging at the hospital while continuing to provide essential safety-net services to Nassau County residents.

Elaine Phillips is the Nassau County comptroller.