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September 18, 2014

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UMC, nursing homes face cuts under Medicaid plan

CARSON CITY -- University Medical Center in Las Vegas and Nevada nursing homes are two of the big losers under the plans by President Bush to cut the Medicaid budget, officials said Tuesday.

"Our total exposure is $20 million if not more," UMC's Mike Alastuey said.

Chuck Duarte, chief of Nevada's Medicaid program, told a joint legislative budget committee Tuesday that $10 million less a year would be going to Nevada's nursing homes under the Bush plan. And the rates paid per day per patient by the state would be reduced.

Assemblywoman Sheila Leslie, D-Reno, chairwoman of the budget committee, said, "It is shameful they are trying to balance the (federal) budget on Medicaid. This is going to be a big problem."

She complained that Nevada was 50th in the nation in the amount the state gets back from the federal taxes paid by its citizens.

State Human Resources Director Mike Willden said he did not know the total impact on Nevada from the proposed cutbacks in the Bush budget. But he said the Medicaid budget nationwide is a $60 billion reduction.

Duarte also said that in addition to the direct impact on hospitals and nursing homes, the state would receive $22 million less a year.

"If all goes as suggested, there will be a $22 million hole in the (state) budget" as result of the planned Medicaid cuts, he said.

Part of the property tax from each county comes to the state to be used to match federal funds for Medicaid. Duarte said the Bush administration believes use of the intergovernmental transfers is "cheating" the nation's taxpayers.

He said he wished the federal government was more focused on the fact that "the patient is on the other end of the dollar."

UMC gets extra money from the state to take care of a large percentage of indigent patients.

And under two federal-state programs, UMC and other county hospitals would lose $29 million in 2006, said Patrick Cates, administrative service officer for the state's Medicaid program.

Two years ago, the nursing homes in Nevada came up with the idea of impose a 6 percent tax on themselves and let the state use the money to draw in federal Medicaid funds. With those extra federal funds, the rates paid by the state were raised.

The state was paying an average of $122 per day per patient to the nursing homes in 2003. After the tax was imposed, the state paid $157 per day per patient, using the extra money coming from Medicaid.

Duarte said the nursing homes realized a $19 per day benefit, after the tax deduction was figured in.

The Bush administration wants to limit the tax to 3 percent and "the net benefit would be cut in half," Duarte said.

Leslie said it would be hard "to take away money after it is given," referring to a possible reduction in the state payments to the nursing homes. Durate said there could be pressure on the state to keep the same payment level without the extra federal money.

Duarte also explained how the state was trying to dovetail its pharmacy programs for the elderly into the new Medicare law that provides drug assistance to the elderly.

He said his state Health Care Financing and Policy Division, is working on coordinating Medicaid, the state's Senior RX program and the federal drug program. There are several options, Duarte said, but it won't be clear until October or November on which one is the best.

Leslie called it a "complicated mess" and it could end up costing the state more money.

"They (the federal government) have thrown a monkey wrench into the whole thing," she said, referring to the problems of coordinating the efforts to make sure seniors get their drugs.

She suggested that "seniors may revolt if they don't get the drugs they're getting now."

Medicaid provides drug coverage for low-income seniors. So does Senior RX, which allows each senior citizen to buy drugs at a discount of up to $5,000 a year.

Leslie said it would be difficult to build a state budget because the answers from the federal government and what action the Congress takes, won't be known until after the Legislature adjourns.