A lot of Social Service agencies are organized on a county level as well. For years I worked for Hennepin County, Minnesota Dept. of Financial Assistance. We administered AFDC & General Welfare payments as well as Medicaid enrollment. I'm not sure of the source of the funds, except that refugee aid was all Federal. The Feds handled SSI & Medicare. Hennepin Co. includes Minneapolis & areas north, south & west. St. Paul is in Ramsey County.

I now live in New York. In Oneida County we are now very well aware that lots of Medicaid funds come from county coffers. We just had a big sales tax increase that no one else in the state has. Here we were thinking it was all Federal or State funds.