LOCKPORT — Nearly 15 percent of the population of Niagara County is on Medicaid, the health insurance program for the poor.

That number has been steadily rising, and the state is working to make it easier to qualify, county Social Services Commissioner Anthony J. Restaino said last week.

Restaino said the county’s high unemployment is only part of the story behind an increase in caseloads that also includes steady growth in the number of people receiving food stamps or cash welfare grants.

Looser eligibility standards and state marketing of social programs also play a role.

The County Legislature last week passed a resolution protesting a new state policy abolishing the requirement for an in-person interview between a caseworker and a Medicaid applicant or his representative.

Legislators feared the policy might encourage Medicaid fraud, but a spokesman for the state Health Department said there’s no going back.

Jeffrey W. Hammond said the no-interview policy is included in the new federal health care reform law, effective in 2014.

“I honestly believe this will spike even higher the number of Medicaid cases in the county,” Restaino said.

He said 20 percent of applicants for social services would fail to show up for their interview appointments and would be automatically rejected.

But now, an applicant need only drop off or mail in an application, and the county must determine his or her eligibility within 45 days.

“How do we know that’s not going to lead to fraud?” asked Legislator Dennis F. Virtuoso, D-Niagara Falls.

“That’s the state law and there’s nothing we as legislators of Niagara County can do about it,” said Legislator Richard A. Marasco, D-Niagara Falls.

“This hearkens back to the driver’s licenses for illegal aliens. It’s just a bad idea,” said Legislator Paul B. Wojtaszek, RNorth Tonawanda.

That was an unpopular 2007 plan from then-Gov. Eliot L. Spitzer, dropped after a few weeks.

“I know New York State is one of the last states in the union that had in-person interviews,” Restaino admitted, “but we’re also one of the few states that has a county share of Medicaid.”

New York counties must pay 25 percent of the cost of Medicaid within their boundaries, which is why Medicaid is the largest single item in every county budget in New York. Niagara County expects to spend $37 million on it this year.

Restaino said the county now has to make a good-faith effort to fill in missing information on a Medicaid application. “Not having the required information does not change the requirement that we determine eligibility in 45 days,” he said.

As of March 31, Niagara County had 21,972 open Medicaid cases, a figure which has risen 26 percent since the beginning of 2008.

Restaino said 32,261 residents are covered by those cases, nearly 15 percent of the population.

The elimination of the interview is only the latest of several changes the state has made since 2007, during the Democratic administrations of Spitzer and his successor, Gov. David A. Paterson.

“We also are no longer required to photo-ID Medicaid recipients,” Restaino told the County Legislature last week.

There used to be a fingerprint requirement for Medicaid, which was dropped in 2008, along with drug and alcohol screening of Medicaid clients.

The state also has increased the amount of money an applicant may earn and still be eligible for Medicaid.

Two years ago, a single person in Niagara County was ineligible for Medicaid coverage if he made more than $311 a month.

In April 2008, that was raised statewide to $673 a month, which was the income level used at the time in Suffolk County, the highest such threshold in the state. Last year, the Medicaid income limit for a single person has been raised to $706 per month.

The impact was immediate. Between March 31 and Dec. 31, 2008, the number of Niagara County Medicaid cases jumped from 17,724 to 19,449, an increase of 9.7 percent in nine months. The caseload rose another 10 percent in 2009 and continues to rise today.

“That’s amazing. There are no words to describe the increases we’re seeing,” said Legislator Danny W. Sklarski, D-Town of Niagara.

The County Legislature also passed a resolution Tuesday urging defeat for a bill put forward by Paterson as part of this year’s proposed budget.

The bill says that if the federal government for any reason disallows Medicaid expenses for which the state sought funding, the cost would be shifted in full to the counties.

Restaino said he and other county officials met recently in Albany with an official of the state Health Department who presented them with this news.

When the county officials asked for an example of a violation that would produce a disallowance that would be shifted from the state to the county, “She could not give us a straight answer,” Restaino said.

The New York State Association of Counties asserts this bill, if passed, will enable the state to evade the cap on county Medicaid cost increases.

County Manager Gregory D. Lewis said the 3 percent cap on Medicaid costs has made it easier to prepare county budgets. “If we get into the disallowance business, it becomes unpredictable again,” he said. “I do think a position should be taken against this.”

The Association of Counties’ president, Thomas J. Santulli, wrote to state lawmakers pointing out that the state sets the rules for Medicaid and the federal government oversees them, and sometimes disagrees with them.

“It generally makes little sense to ignore the state-established framework within which the [county] operates and simply blame the local district,” Santulli wrote.

Food stamp levels are generally tied most directly to unemployment of any of the social services programs, Restaino said. In 2008, the state eliminated the interview requirement and a resource test for applicants.

The recession hit that same year, and the food stamp caseload in 2008 rose 18 percent, from 7,920 at the start to 9,382 at the end of that year. The number of food stamp cases jumped another 20 percent last year and has risen every month so far this year, to a total of 11,850 at the end of March.

“There has been a heavy emphasis by the state on recruiting people [for food stamps],” Restaino said. “I’m sure you’ve seen the billboards.”

The county’s jobless rate was officially 9.9 percent in March, down from double-digit levels, but Restaino said that’s not the whole story.

As of the end of March, 422 Niagara County residents’ unemployment benefits had run out. In the three weeks since, another 109 had exhausted their jobless benefits.

“More than likely, they’ll be showing up at our door,” Restaino said.

Cash public assistance grants also have risen, but nowhere near as fast as the other programs. There were 2,241 cases of cash welfare in Niagara County at the start of 2008 and there are 2,565 today, covering 4,898 individuals.

By coincidence, or maybe not, the county still is allowed to deny cash assistance based on the older income levels that were raised for Medicaid.