Guinn seeks more for Medicaid

Monday, Jan. 31, 2005 | 10:48 a.m.

CARSON CITY -- More than 3,750 low-income pregnant women would be eligible for free medical care and an additional 4,000 children of families of the working poor will have health insurance coverage in the coming two years. And low-paid workers in small businesses that provide health insurance would qualify for a $100 per month subsidy to help pay the premiums.

These are a few of the increases being proposed by Gov. Kenny Guinn in the Medicaid budget that will be examined today by the Legislature's budget committees.

Medicaid trails only the public schools and the University and Community College in the allocations in the state's proposed $5.7 billion two-year budget. Guinn proposes that $836.9 million go to the State Division of Health Care Financing & Policy, the agency that runs the Medicaid program.

The total program cost is more than $2.4 billion with the federal government chipping in 55.6 percent of that total.

In 2004 the average monthly caseload for Medicaid was an average of 172,958 and the average monthly payment was $429, but both are expected to rise sharply. Charles Duarte, administrator of the division, said an average monthly caseload of 205,373 is expected in fiscal 2006 and 227,727 in 2007. The average payment is expected to rise to $433 in 2006 and $438 in 2007, he said.

Assemblywoman Sheila Leslie, D-Reno, a member of the Assembly Ways and Means Committee and chairwoman of the Committee on Health and Human Services, called Medicaid "the budget buster," because of its fast growing numbers.

The big challenge, Leslie said is what Bush administration will do with Medicaid. Word leaking out of the nation's capital is that there are cutbacks planned in the federal share of Medicaid. Leslie said a suggestion for a block grant program would be especially bad for Nevada because the population here is growing so much.

Nevada's Medicaid, said Leslie has the lowest per-capita spending among the states and even if it were doubled, Nevada would surpass only two states. There are not many places to cut Medicaid because the state does not offer many optional programs, she said.

Duarte said Congress could act to restrict funding for Medicaid. That will cause a major problem, he said because by the time Congress approves a plan later this year, the Legislature will be out of session.

Over the next two years, the Medicaid budget has $22 million set aside to provide medical care for pregnant women whose income is just above the Medicaid limit. Duarte said prenatal care will be available and mothers will be eligible for three months care after the pregnancy and children for one year after birth.

Assembly Majority Leader Barbara Buckley, D-Las Vegas, said Friday a legislative study committee on health care options that she chaired recommended the coverage for the pregnant women and the subsidy for the insurance payments for low-income workers.

Buckley said the counties are already spending the money in hospital emergency rooms on the pregnant women who are working. When women don't receive prenatal care, she said there are increased chances of low weight babies or infants with health complications.

By covering these women, Buckley said, health care costs will be lowered without more money being spent in such places at the pediatric intensive units.

Guinn wants to set aside $1.3 million in fiscal 2007 to start a program to provide subsidy of $100 a month pay for health insurance for low-income workers of businesses with less than 50 employees that offer health coverage.

Buckley said a survey showed that of the businesses with nine employees or less, only 36 percent offered health care insurance. "The testimony we (the study committee) received is that they (small business) would like to (offer insurance) but they can't afford it."

Nevada, she said has the fourth highest rate of uninsured in the nation and Buckley "applauded the governor" for including these two programs in the budget.

The budget calls for an additional $7.6 million, of which $2.4 million would come from the state, to enroll more than 4,000 youngsters in a medical health insurance program called Nevada Check-Up. These are children of the working poor. The families would pay a quarterly premium ranging from $15 to $70 based on the family size and income.

During this fiscal year, Medicaid is paying for an estimated 4,100 people in nursing homes. The budget projects the number to go down to 2,929 in each of the next two fiscal years.

"This is one of our success stories," said Duarte. There has been a drive to give more community services so these people can remain in their own homes instead of being sent to a nursing center.

The budget also calls for moving 60 mentally retarded people from intermediate care facilities back into the community where they can get assistance at a lower rate.

To alleviate the problem of overcrowding in the hospital emergency rooms in Clark County by the mentally ill, there was a suggestion that the state increase its Medicaid rate to convince hospitals to open up more psychiatric beds for the mental patient.

But, Duarte said, "we approached the hospital association about a Medicaid increase for psychiatric beds. There was an underwhelming response. There was very little interest in our raising the rates."

The hospitals in Clark County are building medical surgical beds to meet that increased demand and that will generate more revenue for them, he said.

Monte Vista hospital in Clark County now provides psychiatric beds and the state Medicaid program pays $530 per day per patient, Duarte said.

The budget includes increases in the rates paid for air ambulance companies, mental health rehabilitation treatment and home infusion therapy rates. It continues the Medicare rate increases granted to doctors, dentists, hospitals and others in this biennium.

There will be mandatory adjustments in the reimbursement rates this coming biennium for HMOs based on the findings of an actuary and on the ingredients found in prescription drugs. That increase will be determined by the federal government, said Duarte.