EDITORIAL: Medicaid changes hit local nonprofits hard

Dealing with a federal bureaucracy that changes its rules on a whim is bad enough. Trying to get answers and accountability from said bureaucracy can be even more maddening.

Nonprofits that help severely disabled adults and the elderly lead productive lives outside of nursing home care are facing devastating changes in Medicaid regulations that jeopardize their missions and could force them to send clients home. In Las Vegas, affected charities include Opportunity Village (disclosure: Review-Journal publisher Bob Brown is a board member), Nevada Senior Services and Easter Seals Nevada.

As reported Friday by the Review-Journal’s Jennifer Robison, Medicaid regulations require many needy individuals to get outpatient services at nursing homes. During the Reagan administration, however, waivers were instituted so community groups could provide those services. For decades, the waivers have enabled more efficient and more compassionate care for some of society’s most vulnerable residents.

But an initiative to bring greater conformity to Medicaid regulations has some of those waivers disappearing effective Jan. 1. As a result, job-related services and community centers that are located next door to hospitals will lose their funding.

That affects Opportunity Village’s work programs for the severely disabled. Of the $2 million it receives annually to train and employ 200 clients, $1.2 million, or 60 percent, comes from Medicaid waivers, with the state funding the balance. The waivers also pay for Easter Seals’ adult day care program, which takes adults with severe intellectual, psychiatric and behavioral problems on field trips. Both charities have been located on West Oakey Boulevard for decades. But the opening of the state’s Rawson-Neal Psychiatric Hospital next door after the groups were established could disqualify them from future Medicaid funding. The new rules also threaten Nevada Senior Services’ health care programs.

It’s not hard to believe some rule-writing bureaucrat in Washington has the power to cause such upheaval with the stroke of a pen. Proving why many people now consider federal regulators the leviathan “fourth branch” of government, no one can get answers to their questions or a forum for their concerns. Opportunity Village Executive Director Ed Guthrie told Ms. Robison the group submitted comments on the proposed rules in 2010, 2011, 2012 and 2013 and never received a rationale for the changes or whether they can be scaled back. Nevada’s congressional delegation tried to intervene by sending a letter to Health and Human Services on Sept. 24, but Mr. Guthrie said there has been no response to that communication, either.

“Nobody has presented a compelling argument to show things are so bad that we need to make a change,” Mr. Guthrie said. “We just have some people who think they’re visionary who are going to impose their vision on other people.”

Nursing homes, which provide 24-7 care, are considerably more expensive than charity-based care programs. In addition to harming these organizations, the new rules likely will cost taxpayers even more money.

“There’s no replacement (for funds) in place. It would put a lot of people in institutions,” Nevada Senior Services President and Chief Executive Officer Jeffrey Klein said.

When members of Congress can’t break down any barriers within the bureaucracy they oversee, America has a problem. These rule changes are harmful, counterproductive and make no sense. If it takes new legislation to undo them, Nevada’s delegation should make it happen.

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