State, feds pummel programs for poor

By Cy Ryan (contact)

Thursday, March 6, 2008 | 2 a.m.

Carson City — Like a target on a firing range, the state Health and Human Services Department is taking a lot of hits.

“We’re getting squeezed from all sides,” says Director Mike Willden, referring to programs that help the poor, children and the elderly.

The first blow was delivered by Gov. Jim Gibbons, who ordered a 4.5 percent reduction in agency budgets. The latest blow comes from the Bush administration — a cutback of as much as $120 million for Medicaid over the next five years.

That could mean a reduction for services such as mental health and less money for public hospitals, nursing homes and schools.

This comes at a time when the faltering economy is causing more people to seek state medical services, Willden says. He’ll have to transfer more than $20 million from next fiscal year’s budget because of the increased number of Medicaid patients.

In October the federal government will reduce its contribution to the state’s Medicaid program, another $19 million to $20 million hit.

“We’re getting nailed from all sides,” says Charles Duarte, chief of the state Health Care Financing and Policy Division, which runs the Medicaid program. “It forces us to spin our wheels. It creates a sense of unease among parents and providers whether the services will continue to exist.”

Medicaid covers an estimated 165,000 low-income people including parents and children, the elderly and the disabled. The state this biennium is chipping in $908.5 million.

Among the federal dollars the state could lose:

• $100 million over five years for “treatment homes.” These provide round-the-clock mental health care for an estimated 400 children. The alternative is putting these children into a lockup facility or a hospital. “That’s cruel and more expensive,” Duarte says. “It’s not helping these children. It’s hurting them.”

• $4.2 million for reimbursement for graduate medical education. University Medical Center in Las Vegas would be the big loser.

• Reduction in payments to hospitals for Medicaid outpatient care for such things as X-rays and emergency room services. There is no estimate of how much would be lost by UMC and the hospitals in rural Nevada, Duarte says.

• $28 million for case management, including time spent by state workers in courtrooms explaining to judges how neglected or abused children on Medicaid are being cared for.

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Clark County projects want for more than half of the state’s $3.1 million budget for restoration of historic buildings.

The state Commission for Cultural Affairs is meeting to review requests for $8.9 million for 31 projects.

The biggest request comes from Las Vegas, which wants $1.1 million to continue the restoration of the federal building-post office. Historic Preservation Administrator Ronald James says the commission granted $475,000 to the project in the last go-round.

James estimates the cultural commission has given about $2 million total for the post office.

Other requests from Southern Nevada are $210,000 from the Clark County Parks and Recreation Department for work on the Candlelight Wedding Chapel and $336,412 from the Neon Museum for the La Concha Motel lobby.

The meeting to review and approve grants is set for March 20-21 in Carson City.

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The financially troubled Las Vegas Monorail gets to keep its tax-exempt status for another five years.

The monorail is considered a “charitable” venture under Nevada law, exempting it from paying state sales and use taxes on purchases. Its tax-exempt status was set to end March 20, but the Nevada Tax Commission voted Monday to extend it.

That could save millions of dollars if the monorail expands to McCarran International Airport or to the west side of the Strip.

Curtis Myles, president and chief executive officer of the system, told the commission the exemption saves about $90,000 a year on equipment purchases. But the system saved more than $6 million when it was built. It would save more on an expansion because of inflation.

Myles says the system carries almost 8 million passengers a year, takes in more than $32 million in fares and earns more than $3 million from advertisements.

Its operating costs are more than $27 million, leaving $6 million to $7 million to pay off the construction bonds. But the debt service is $34 million, Myles says, so the system is dipping into its reserve to meet that obligation.