Lawmakers rethinking health plan for poor

Wednesday, May 6, 1998 | 9:01 a.m.

The Legislative Committee on Health Care later this month will re-examine the idea of moving almost half the state's 97,040 Medicaid recipients into managed care starting Oct 1.

Charlotte Crawford, director of the Department of Human Resources, said any major changes to the proposal at this late date could jeopardize the start-up date.

Some lawmakers on the Health Care Committee, which met Monday, are questioning the wisdom of moving forward with a program that could save only about $1 million to $3 million a year but possibly harm southern Nevada's public hospital.

The switch could have a serious effect on University Medical Center by transferring Medicaid patients now served at the public hospital to for-profit hospitals. The switch would involve welfare recipients and those enrolled in a program for pregnant women and children, totalling about 48,000.

William Hale, chief executive officer at UMC, has repeatedly told lawmakers that the financial consequences could be severe. The hospital broke even in 1997 with $255 million in operating expenses and revenues, according to a new hospital profit report.

Crawford said the hospital would suffer a loss of $10 million a year in Medicaid funds in a worst case scenario - and much less if it became a part of a managed care organization that participated in the delivery of care to Medicaid patients.

There are other, more important reasons for moving to mandated managed care than financial savings, she said, adding that contracting with managed care organizations will allow for better quality assurance and ensure that Medicaid recipients will have access to care.

The Legislature has repeatedly supported moving into mandatory managed care, which would place Medicaid recipients in a health maintenance organization to receive medical care. The state pays the fees for medical care provided by doctors and hospitals to Medicaid recipients, a system called fee for service.

But the questioning from some of the Health Care Committee members has left Crawford in a quandary.

"We're in a very difficult spot," she said. "We do feel like the legislators need to have a discussion with each other so we know whose direction to follow here. We don't wish to defy any of them."