Clark County seeks refund from state

Clark County's battle to recoup
$102.5 million in revenues that were diverted to state coffers three years ago entered a new phase this week.

As part of a discussion with Gov. Brian Sandoval's office that county officials hope will lead to some sort of refund, the County Commission unanimously voted to keep $16.4 million in the county general fund originally allocated to pay the state for access to additional Medicaid funding for University Medical Center. It's being treated as a sticking point in that larger discussion, according to county sources.

County officials contend a Nevada Supreme Court ruling in May requires the state to return the money. The court held that the state had to return $62 million in Clark County Clean Water Coalition funds taken by the Legislature in 2009. The court ruled that such money grabs were unconstitutional because money was not taken uniformly from all 17 counties.

County Manager Don Burnette declined to comment about negotiations with the state.

The county entered into two agreements last year to transfer funds to the state to make the federally required match for access to federal funding for the county's only public hospital.

A third agreement, which was amended by the County Commission on Tuesday, requires the county to transfer additional funds that are voluntary contributions beyond what is required to make the federally required match for inpatient, outpatient and medical education hospital services.

The financially-strapped UMC lost more than $70 million for the third straight year in 2011 and performs millions of dollars of free work for indigent patients.

Tuesday's vote to keep the $16.4 million meant to support the Upper Payment Limit Program in fiscal years 2010 and 2011 didn't sit well with state officials. The state uses that money to pay Medicaid providers, hospitals and pharmacies statewide.

While UMC won't see a direct effect from the savings, it will come as a "relief to the county and county taxpayers," a source said.

The county will make only the voluntary contributions in fiscal years 2012 and 2013.

The combined retroactive contributions from the rest of the state total $289,000 -- a contrast to the millions of dollars provided by the county.

"It just seems like Clark County taxpayers are subsidizing everybody else," County Commissioner Steve Sisolak said.

Mike Willden, director of the state Department of Health and Human Services, said the vote doesn't change the contract between the state and the county.

"It won't take effect until we mutually agree," Willden said. "So we'll be in a legal loggerhead at some point in time here, and we will have to sit at the table and figure it out."

Willden confirmed to commissioners the money was set aside in a reserve account meant to be used for the future of the statewide plan.

But Commissioner Larry Brown said the court ruling was clear.

"There's an inequity here," Brown said. "Fundamentally, we're at a point where we have to protect those dollars that our residents are paying to us for these types of services, especially in the context of the (Nevada) Supreme Court ruling."

Charles Duarte, administrator for the Nevada Department of Health and Human Services' division of health care financing and policy, said that Clark County approached state officials in 2004 to craft a deal that would draw federal dollars to take care of recipients statewide.

About 72 percent of Medicaid recipients in Nevada are in Clark County and Las Vegas.

"This is not something we did to you," Duarte told commissioners. "It was something we were asked to do."

Burnette tried to steer the conversation back to the $16.4 million agenda item, but commissioners chimed in.

"At the end of the day you guys are heading to the airpor,t but we have to stay here and answer to our constituents as to how we're going to keep these doors open and how we're going to be fiscally responsible with their tax dollars," Commissioner Lawrence Weekly told state officials.

Contact reporter Kristi Jourdan at kjourdan@reviewjournal.com or 702-455-4519.