Plan could be costly to Nevada

<b>CORRECTION:</b> This story in Monday's Review-Journal about the health care bill before the U.S. Senate Finance Committee contained an error. Senate Majority Leader Harry Reid, D-Nev., placed in the bill a clause that Nevada and three other states would not have to pay any increased costs for Medicaid if the bill wins approval. The insertion was not in the form of an amendment.

CARSON CITY -- The number of Nevadans receiving free medical care would nearly double by 2015 under provisions of the health care bill being developed in the U.S. Senate Finance Committee.

A record 222,022 residents now receive medical care through the state-federal Medicaid program. That total would increase by 217,000 under the national health care bill, according to an analysis done by the state Health Care Financing and Policy Division.

The move to expand Medicaid comes at a time when the state can least afford it, although Senate Majority Leader Harry Reid, D-Nev., has proposed an amendment to prevent Nevada from absorbing additional costs under the health care bill.

But Charles Duarte, administrator of the division, is not convinced the amendment will be approved.

If it fails, then Duarte said Nevada would be responsible for 13 percent to 18 percent of the costs of adding the 217,000 new Medicaid recipients, along with what it already pays for the current recipients.

Providing Medicaid to Nevadans already costs the state about $1.5 billion a year, of which $450 million is state funds, Duarte said. Medicaid is the second most costly state government expenditure, trailing only the funding of public education.

Already state government faces a potential $2.4 billion shortfall for the 2011 legislative session.

The additional Medicaid costs would be considerable, according to Duarte, although he has not made any estimates yet.

Reid already has run into criticism from Sen. John McCain, R-Ariz., and other Republicans who contend he is trying to bring home extra money for Nevada as his re-election bid approaches.

"There are 574 amendments to the health care bill," Duarte said. "Lord knows what is going to happen. While we are grateful folks are considering 100 percent federal funding for states like Nevada, what happens with the next recession?"

Duarte said recently he will have to seek another $37 million from the Legislature in 2011 because the current Medicaid enrollment already is 11,000 people above the level funded for in June.

A U.S. Census Bureau study last week found 21.3 percent of Nevadans lack health insurance, ranking only behind New Mexico and Texas. Nevada's 20.2 percent unemployment rate for children under 18 was highest in the nation.

Still, state authorities noted that the enrollment in Nevada Check Up, a free health care program for poor children, was down 2,700 recipients in the past year.

Duarte estimated Tuesday that as many as 75,000 Nevadans who qualify for Medicaid have not enrolled in the program.

I don't know why," he said. "You would expect they would apply under the current criteria. Some may view it as a hassle."

Illegal immigrants are not eligible for Medicaid, but under federal law the state must compensate hospitals that provide emergency care for them.

Ben Kieckhefer, a spokesman for the Department of Health and Human Services, said Nevada has some of the strictest requirements for Medicaid qualification in the country.

Adults without children qualify for Medicaid only if they earn less than 25 percent of the federal poverty level of $10,830 per year. That means an adult would have to earn less than $2,708 a year.

Children 6 and younger are eligible for Medicaid if the family earns no more than 133 percent of the poverty level. Children 7 to 18 qualify if the family earns 100 percent of the poverty level. For a family of three, the poverty level would be $18,310 a year.

Kieckhefer said Nevada's Medicaid qualification rules are so strict that unemployed people receiving benefits do not qualify because their compensation is too high.

Under the health reform bill in the Senate, Medicaid would be given to all members of a family if its total earnings do not exceed 133 percent of the poverty level.

In contrast to Nevada, Kieckhefer said New Mexico provides Medicaid to all members of a family whose total earnings are less than 235 percent of the poverty level.

Besides the poor, Medicaid also is provided to foster children, adopted children, the blind and disabled.

Although the state has had difficulty in finding doctors to treat children with special medical problems at the reimbursement rates it pays, Kieckhefer said, for patients needing treatment for more general medical problems, enough doctors have been willing to accept Medicaid patients.

Overall, Duarte is pleased Congress is trying to come up with a plan to ensure everyone has health care coverage.

He noted health care costs in America are increasing three times as fast as wages.

"We can't stay where we are now," he said. "As a public administrator, I am concerned what the states will pay will end up being a lot more if reform doesn't happen."

Contact Capital Bureau Chief Ed Vogel at or 775-687-3901.