Medicaid might give state more time

The future of Nevada's services for foster children with severe emotional problems is riding on a tentative commitment from federal Medicaid administrators.

On Monday, Nevada Division of Child and Family Services administrator Fernando Serrano told legislators that Medicaid officials verbally agreed to give the state an additional six months to work out their disagreements over a new plan.

Nevada's proposed Medicaid plan was submitted to The Centers for Medicare and Medicaid Services two years ago. Approval has been delayed by pending changes at the federal level that would discontinue payment for services related to child welfare.

Half of Nevada's $16 million expenditure for therapeutic foster care comes from Medicaid. The other half is a match in state funds. Therapeutic foster care allows children to receive mental health services while living in a familylike setting. Providers of therapeutic foster care have become concerned about the uncertainty surrounding Nevada's Medicaid funding.

That uncertainty is likely to continue until a state plan is in place, said Clark County Family Services Director Tom Morton

"This is the promise of an extension, not a guarantee," Morton said Monday.

"It leaves everyone uncertain as to what will be in the final plan."

Charles Duarte, administrator for the Nevada Division of Health Care Financing and Policy, said that the federal commitment to extend Medicaid funding is on shaky ground.

In his last conversation with the agency, Duarte said that he was told the extension depends on Nevada's willingness to change its accounting methods for Medicaid services.

"They've now said that they may reconsider the verbal commitment unless we want to make changes," Duarte said Monday.

"But we're not sure what they want us to change. They've given us no definitive guidance on what they want."

Duarte said he hopes to reach an understanding with Medicaid officials by the end of the week.

The issue of paying for therapeutic foster care arose as legislators on the committee to study the placement of children in foster care met for the first time. The committee, led by Sen. Steve Horsford, D-Las Vegas, will look at ways to reduce the number of children in foster care and to devise standards for deciding whether a child should be placed in foster care.

With such goals in mind, Morton said, now is not the time to consider a reduction in child welfare services.

Keeping children safely at homes where abuse and neglect are issues requires support in mental health services, domestic violence programs and close monitoring, he said, and those services might be affected by 8 percent budget cuts being considered by Gov. Jim Gibbons.

Although child welfare is exempted from such cuts, mental health services and domestic violence programs do not have that same protection, Morton told legislators.

"It's very important to look at the impact of potential cuts on the goal of keeping kids home safely," Morton said.

Contact reporter Lisa Kim Bach at lbach@reviewjournal.com or (702) 383-0287.