UMC pushes program for uninsured residents

Jeff Schweers

Wednesday, June 4, 1997 | 10:33 a.m.

Now that a bill by Columbia/HCA Healthcare Corp. to overhaul medical care for indigent patients and provide insurance for the working poor is dead, the County Commission has decided to push its own Medicaid reform measure.

The board on Tuesday gave permission to University Medical Center director William Hale to approach the Legislature with proposed wording for a bill.

"There has been much discussion about the need for Medicaid reform and, specifically, about the development of a medically needy program," Hale told the commission during a presentation Tuesday.

The county's proposal would maximize federal dollars without increasing the local match. The Columbia/HCA proposal, Assembly Bill 410, would have cost UMC $26 million in revenue losses.

Assembly Speaker Joe Dini, D-Yerington, asked that Columbia/HCA withdraw the bill and said he will ask state experts and lawmakers to also pursue an alternative to the legislation.

Hale said no organization is more experienced or better suited than UMC -- the county hospital -- to provide health care to people who can't afford it.

"Clark County has provided care to the indigent population of Southern Nevada since 1931, when UMC was conceived on the poor farm located on the outskirts of town," Hale said. "UMC operates several clinics devoted primarily to the treatment of this population."

Last year, he said, the adult outpatient clinic handled more than 55,000 visits, the pediatric outpatient clinic handled more than 8,000 visits and the University Women's Center had nearly 40,000 patient visits.

Each of those clinics provide ongoing primary care to all patients as well as specialized clinics from oncology to cardiology, he said.

"UMC has created a managed care environment for these patients while limiting administrative costs often associated with other delivery systems," Hale said. And that can head off catastrophic illnesses, which can save society millions, Hale said.

"UMC -- in conjunction with Clark County Social Services -- are the experts when it comes to the care of the uninsured," he said.

From that experience, Hale said, UMC has crafted what he called a "revolutionary approach" to health care in Nevada. Called a County Organized Health System, the program would maintain care of the uninsured at the county level, "where it belongs," Hale said.

A similar program existed until several years ago when it was discontinued by the federal government, County Manager Dale Askew said, but now the federal government is more inclined to give back local control.

"It's a good plan," said Commissioner Myrna Williams, who wanted to make sure the state Medicaid director knows about the proposal. "My only concern is that somebody doesn't get their nose out of joint and work against it."

Establishing such a program requires legislative action and approval by the federal government as a Medicaid Demonstration Project under Section 1115 of the Federal Social Security Act.

The proposed program, to be phased in over five years, includes the following elements to help address the growing uninsured and working poor populations in Clark County:

* Turning over to Nevada's counties the responsibility for managing the Medicaid population within their borders;

* Expanding the Medicaid program to include an additional 100,000 uninsured Nevadans by maximizing federal matching dollars without increasing state or local taxes;

* Assigning a primary care physician for each patient through UMC for the first two years, with expansion to the private sector in the program's third year;

* Creating a new state administrative position to oversee the transfer of local, state and federal Medicaid matching funds.

Clark County would be responsible for running the program within its jurisdiction, and benefits and payments for existing Medicaid recipients would not change in the first year of the program. The county would concentrate on development of the medically needy program.

Clark County Social Services would be responsible for determining who is eligible for the program, while a third-party administrator would be hired to process claims and provide utilization review.

As the system evolves, the UMC and Social Services would blend to care for an estimated 100,000 uninsured Nevadans, most of whom reside in Clark County, Hale said. Clark County has an estimated 209,000 uninsured residents.

"Access to all health care services will be improved for those individuals in the project who were not previously part of the Medicaid system," Hale said.

Not only would the program maximize federal dollars immediately without raising state or local taxes, Hale said, it would minimize the impact if the disproportionate share program is eliminated at the federal level (for which UMC receives millions in subsidies each year).

Eligibility for enrollment would be limited to families at or below 150 percent of the federal poverty level.

Commissioner Lorraine Hunt wanted to know how undocumented aliens would fit into the program.

"We take care of anyone regardless," Hale said. "Under the federal law they wouldn't qualify, but would be included in our primary care program."