Vulnerable New Yorkers who rely on Medicaid for their healthcare were front and center at Mayor Bill de Blasio's preliminary budget announcement on Thursday afternoon, as the mayor warned of possible Medicaid cuts up to $2 billion in New York City alone.

De Blasio said the cuts would come from Albany, weeks after Governor Andrew Cuomo suggested cities should front more cash to help the state close its $6 billion budget gap, $4 billion of which represents the Medicaid deficit.

The city's Health + Hospitals would carry the brunt of the costs under any cuts to the Medicaid program, de Blasio said.

"I mean you're talking about a lot of families who need health care who just wouldn't get it," de Blasio told reporters Thursday. "Clearly this would endanger the strength of Health + Hospitals. It would mean less personnel, it would mean longer wait times."

De Blasio issued a $95.3 billion budget, a 2.7 percent increase from last year. City Hall said it was "crafted in light of" the state's budget gap—which Cuomo suggested in his State of the State speech would lead to localities paying their share of local Medicaid costs. "It is too easy to write the check when you don't sign it," Cuomo said, calling the situation "unsustainable."

Cuomo's top spokesperson quickly denied that the state would put Medicaid burden on localities—and another gubernatorial spokesperson called it "smoke and mirrors" on Thursday, downplaying the fear of Medicaid cuts.

"We heard some different things from the Governor this week, but the proof will be in the pudding first with the Governor's budget address next week and then, ultimately, with the final budget, give or take, April 1st," de Blasio said. "But we do know that we've never seen this kind of State deficit. We've never seen this kind of threat to our Medicaid recipients."

Cuomo spokesperson Dani Lever said, "How the mayor can claim he is reacting to cuts from the State before the State has even proposed a budget is spreading the political cream cheese too thick even for a toasted bagel," poking fun at de Blasio's apparent bagel choice. (Cuomo's office did not respond to follow-up questions Friday).

But Andrew Rein, the president of the Citizens Budget Commission, told Gothamist, "The mayor was right yesterday to be cautious."

"The state has a big problem that it has to solve," Rein said. He said the state should restructure Medicaid, the federal-state program that gives insurance to low-income people and children at the state-level, and find cost savings on fraud and administrative waste. If the governor were to punt Medicaid costs to cities, "it would be a total reversal of one of his signature achievements" from 2012, when the state began funding a larger share for Medicaid programs, Rein added.

Health + Hospitals already faces $30 million in cuts after a 1 percent rate cut for Medicaid was implemented on New Year's, the health system's spokesperson confirmed. The health system has stopped administrative hiring in the interim.

"State cuts to Medicaid reimbursement threaten NYC Health + Hospitals’ ability to deliver quality healthcare to more than a million of the most vulnerable New Yorkers every year," Stephanie Guzmán, a Health + Hospitals spokesperson, said in a statement. "NYC Health + Hospitals is prepared to work with the city and state to come up with a budget that lets us mitigate any possible cuts and allows us to take care of our patients."

The City Council emphasized working with Albany to solve the issue.

"We are keenly aware of the challenges presented to the City this year by the $6 billion state budget deficit, which is largely driven by the $4 billion Medicaid shortfall," City Council Speaker Corey Johnson, Finance Committee Chair Daniel Dromm and Capital Budget Subcommittee Chair Vanessa Gibson said in a joint statement.

"The full impact of this deficit is unknown at the moment, but we will continue to work with our partners in state government to do everything we can to make sure that our 8.6 million constituents don’t lose critical services they depend on," they said.

Medicaid and the MTA were the two "big financial challenges," de Blasio said. He lamented the state asking for $3 billion for the MTA and $100 million for Access-a-Ride, noting 70 percent of the MTA's annual resources already originate from the city and its resident, workforce and visitors.

"We're going to deal with both of them, but this is going to be the story that really determines what our City budget ultimately looks like," he said.

Other highlights in de Blasio's preliminary budget include $106 million for the Fair Fares program, $98 million in Vision Zero efforts for Fourth Avenue in Brooklyn, $178 million in curb cuts to make sidewalks more accessible, $12.9 million for NYCHA's community centers, and $33 million to supplement a U.S. Army Corps of Engineers resiliency project.

The city's budget won't be finalized until June, about two months after the state budget is typically set. Cuomo will announce the state's budget proposals on Tuesday.

"It's interesting," Rein said. "We will learn so much on Tuesday—almost more than we did yesterday—on what's going to happen on the city budget."