Las Vegas Sun

April 20, 2014

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Doctors: Medicaid cuts will decrease access for Nevada’s poor

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CARSON CITY – A parade of Las Vegas anesthesiologists testified Tuesday that cutting their Medicaid rates would mean less service to poor and severely ill patients.

Dr. Jonathan Zucker told the televised public hearing that the 45 percent proposed reduction approved by the Nevada Legislature will mean “decreased access to Medicaid enrollees.”

Dr. Elliot Klain said the $37 rate per 15 minute unit hasn't been increased since being set in 1980, yet the cost of doing business has risen. And now it is going down to $21.

“Medicaid is a charity rate,” Klain said. “We can’t give that much charity to the state.”

There are an estimated 242,000 people enrolled in Medicaid in Nevada.

Dr. Charles Mason told the hearing that Gov. Jim Gibbons proposed cutting government by 10 percent. But anesthesiologists have been hit with a reduction of more than 45 percent.

“I’m not sure how well the Legislature was informed,” Mason told a reporter after the hearing.

Charles Duarte, director of the state Division of Health Care Financing and Policy, says the reduction was ordered by the Legislature and it will be effective March 15 if the federal government approves the cutback. The federal government contributes to the program.

Duarte warned there “will be further cuts in the next budget unless a miracle happens” with the looming $3 billion shortfall in state revenue.

Duarte said the division initially proposed to cut dentures, physical therapy, occupational therapy, speech therapy, audiology, hearing aids, treatment for traumatic brain-injured individuals and home-based community care services.

These services were being eliminated until the Legislature reconsidered those, Durate said. Other groups such as hospitals, doctors and personal care attendants have had their rates reduced previously for treatment of Medicaid patients.

The public hearing was conducted by Durate’s division and attracted a large number of anesthesiologists from Las Vegas. The Legislature reduced the Medicaid budget by $2.9 million with cuts in anesthesiologist rates and other services.

Larry Matheis, director of the Nevada State Medical Association, said “access will be more difficult” for Medicaid patients if these rates are reduced.

Zucker said in a letter to the state that “anesthesia providers in Nevada will become so disenchanted with providing 24/7 services to Medicaid enrollees under such bitterly austere conditions, they will inevitably decline to participate in the Medicaid program.”

Duarte told the hearing that Nevada was not the only state reducing Medicaid services. He said Arizona is now paying in IOUs. California is giving up all optional services and Hawaii is unable to pay for the services.

“We’re dealing with a cash situation,” Duarte said. And the elimination of services proposed earlier will be “back on the table” in preparing for the budget to be presented to the 2011 Legislature.

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