Cuts would hurt neediest most

By David McGrath Schwartz, Cy Ryan

Friday, Oct. 17, 2008 | 2 a.m.

Thousands of poor children cut off from health insurance. Bigger classes in elementary schools. Three hundred mentally disabled people losing housing assistance.

A grim picture emerges in budget documents detailing the future of state government under proposed budget cuts, the deepest since the Great Depression. Over the next two years, Nevada’s government, far from robust to begin with, will be able to provide fewer services at a time when the number of residents seeking welfare, unemployment benefits and health care aid is expected to rise.

“We’re doing harm,” said Mike Willden, director of Health and Human Services. “Absolutely, we’re doing harm.”

Documents showing agency recommendations for the upcoming state budget became public this week. It’s clear there are few painless decisions in the spending reductions brought on by a sharp decline in the state’s economy.

The Education Department, for example, is recommending money for new text books and instructional supplies be cut in half, saving $67 million.

The Corrections Department’s budget calls for closing the Nevada State Prison in Carson City and prison camps in Pioche and Tonopah at a savings of $25 million — moves that will likely result in prison staff being laid off.

At Health and Human Services, the agency recommends eliminating nonemergency vision care and orthodontia for uninsured children in low-income families.

Scaling back bathing, grooming and dressing services for an estimated 1,600 homebound elderly and disabled citizens will save another $12 million, and cutting housing support for 85 mentally ill Las Vegans will save $2.2 million.

“It’s ugly. We’ve been preparing for ugly,” said Ben Kieckhefer, the governor’s spokesman.

“We’re not going to help everyone who needs help,” he said. “People are struggling, and we’re putting people in a position to struggle more. It’s tough to stomach.”

The governor has not seen all the proposed cuts but will receive a “comprehensive briefing” next week, he said. But, Kieckhefer added, “the governor believes the state has to make do with the revenue it has.”

Gov. Jim Gibbons instructed the heads of state government departments this summer to prepare spending plans for the next two years that are 14.12 percent below funding levels approved by the Legislature in 2007.

Since then, the state’s economic outlook has grown grimmer, leading Assembly Speaker Barbara Buckley, D-Las Vegas, to say cuts could grow to 18 to 20 percent. Gibbons last week did not dispute that assessment.

The proposed cuts released this week could be adjusted by the governor. The state’s spending plan also must be approved by the 2009 Legislature, which convenes in February.

The governor isn’t required to release his final proposed budget — which covers the two years from July 1, 2009 to June 30, 2011 — until January.

Kieckhefer acknowledged that there isn’t much room for adjustment.

Welfare

The proposed welfare budget calls for closing offices in Yerington, Winnemucca and Hawthorne and the Owens Avenue office in Las Vegas, and eliminating 116 frontline case workers. That means the department will be slower to process applications for welfare recipients, the aged and blind.

With the economic downturn, the welfare division estimates its cases in the temporary assistance to needy families program will rise 9.4 percent in 2010 and 10.4 percent in 2011. The division is recommending a reduction from $9 million to $6.5 million a year for child care discretionary grants to families. Welfare Administrator Nancy Ford said these are families whose income is too high to qualify for welfare or other programs, but that need help paying for child care while a family member is in training, in school or in a low-paying job.

Ford said she’s going to retire Oct. 30 after seven years in the job and 30 years in state government. The state’s budget problems helped her conclude that now is the right time.

“It’s pretty ugly out there,” she said.

Mental health

Harold Cook, administrator of the Mental Health and Developmental Services Division, said the proposed cuts will lead to “less access to services, reduced services to those receiving services and longer waits for those wanting services.”

Patients in rural Nevada seeking care for mental illness, substance abuse and developmental disabilities will have to travel longer distances because of the office closures, Cook said.

The division’s proposed budget would cut 96 workers at the Rawson-Neal mental health hospital in Las Vegas. But Cook said he thinks the state can provide the same level of care to patients while bringing staffing ratios more in line with national standards.

There will also be a cap on autism treatment programs throughout the state. In Clark County, the state will treat only 21 patients and waiting lists will grow.

“Studies indicate early intervention helps reduce the long-term effect of autism,” Cook said. “Waiting longer for service will hinder progress and increase the long-term care costs.”

Medicaid

The most significant effects on the state’s Medicaid program will come in hospital services and long-term care for the elderly and disabled, said Chuck Duarte, administrator of the Health Financing and Policy Division, which runs the program.

The state has imposed a 5 percent cut in payment rates to hospitals and the plan is for another 5 percent reduction. Willden said complaints are flowing in from hospitals and doctors, and many physicians say they will no longer take new Medicaid patients, or drop the ones they see.

“What it will cause is access problems,” Willden said. “Low-income families, seniors, the disabled will find it harder to find health care providers, because many won’t accept Medicaid.”

Nevada Check Up, which provides health insurance to low-income children, will cap enrollment at 25,000, Willden said. There are almost that many children in the program now, with another 4,000 on the waiting list. The savings will total $3 million.

Duarte said even with these and other reductions, the department’s budget will be higher because of more cases and inflation, which under federal law the state has to account for.

Applications for Medicaid rise with unemployment, which is predicted to climb from the current 7.1 percent to 8.5 percent next year.

Education

The amount per student the state sends to school districts would be reduced by as much as $120, from the current average of $5,213.

Keith Rheault, state superintendent of public instruction, said the cuts, which would save $51 million, won’t allow for new programs or innovations in public schools.

“It doesn’t give one more dollar to the districts to do something better,” Rheault said.

Also lost will be the $2,000 bonuses used to recruit teachers to Nevada. Rheault said districts consider the money “critical” to luring teachers to the state.

The proposed budget would also eliminate extra retirement credits and bonuses for teachers working in at-risk schools or in hard-to-fill positions in areas such as mathematics, science, special education, English as a second language and school psychology.

Rheault said “thousands” would lose the extra benefit at a savings of $26.1 million.

The recommended cuts would also translate into larger classes in the primary grades. One student would be added to the 1-16 teacher-pupil ratio in first and second grade and to the 1-19 ratio in third grade.

“Everybody is going to share the pain,” Rheault said.