Thursday, Jan. 20, 2005 | 10:50 a.m.
CARSON CITY -- Growing anxiety that the federal government is going to pull back on its financing of Medicaid -- the program that provides medical care for the poor, elderly and disabled -- has the nation's governors afraid that the states will have to pick up more of the costs.
In Nevada, Medicaid already is the third most costly program behind public schools and the university system.
Gov. Kenny Guinn, in Washington, D.C., for the inauguration of President Bush, met Wednesday with 11 other governors in a strategy session to head off any reductions.
"There is (bipartisan) concern across the board," said Michael Hillerby, Guinn's chief of staff, who also attended the session.
The National Governors Association has already sent a letter to Congress, urging it to reject any pullback by the federal government. Hillerby said Guinn intends to be in touch with the Nevada congressional delegation "to make sure they know the ramifications" of any reduction that may be suggested by the Bush administration.
There were no final decisions made by the governors because Bush has yet to lay his plan on the table, said Hillerby. But the governors are preparing for a lobbying effort in Congress.
This fiscal year $323 million has been set aside in state money for Nevada to pay its share of Medicaid. That trails the $884 million in the general fund going to the public schools and the $506 million to the University and Community College System of Nevada.
The overall Medicaid cost is split between the states and the federal government. In Nevada's case, the federal government pays 55.6 percent and Nevada picks up the remaining 46.4.
Hillerby said there is no "firm proposal" on the table now as to what Bush intends to do, but the president is trying to cut the national deficit, and word of the pending reductions in Medicaid funding has leaked out from the federal agencies.
Charles Duarte, administrator of the state Division of Health Care Financing and Policy that oversees Medicaid, said he has heard the rumors but added, "The Bush Administration is keeping this pretty close to the vest."
State Budget Director Perry Comeaux said this has been a "constant concern" about the government reducing its aid.
"They talk about cost containment and that means cost shifting," Comeaux said. "And the only place they can shift the costs is to the states."
Since fiscal year 2001, the Medicaid caseload in Nevada grew from 117,643 to an estimated 177,096 this fiscal year, a 51 percent increase.
Nationally the program costs about $300 billion between the federal and state governments.
In Nevada, those eligible for Medicaid are on welfare, low-income pregnant women and children, the blind, aged and disabled receiving assistance and children in the foster care program.
Durate said 69 percent of the cases on Medicaid are families on welfare and those mothers and children who are just above the welfare-income limit but still considered to be living in poverty.
Despite the 69 percent, this group accounts for only 25 percent of the expenditures. The remaining 31 percent are the elderly, blind and disabled and make up 75 percent of the expenses.
About 3,000 of the Medicaid elderly are in nursing homes, Duarte said. Last fiscal year, the state paid $136 million for such elder care. He estimated that 60 percent of the patients in nursing homes are paid for by Medicaid.
Durate said the number of nursing home patients in the program has remained fairly constant because the state has been able to find other care for such patients, such as staying in their homes.
Durate said he hopes that when Guinn returns from Washington he will have more information.
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