Paul Gowins considers himself lucky. Disabled and partially paralyzed for 23 years, he at least has health insurance and a steady job.
Gowins steered his motorized wheelchair before lawmakers Thursday to promote a new program that would allow 600-plus disabled Nevadans to remain on Medicaid coverage when they return to work.
"The option if you don't do this is we're going to stay at home," Gowins told a joint Assembly-Senate money subcommittee. "It'll keep us on the dole."
Lawmakers analyzing Gov. Kenny Guinn's two-year, $645 million Medicaid and Nevada Check-Up spending plan heard details on huge health care programs required by federal government, as well as smaller, optional services like the Medicaid Buy In program favored by Gowins and other disabled activists.
State Human Resources Director Mike Willden said the optional programs -- from prescription drugs to hospice care -- would be cut first if lawmakers slice Guinn's budget, which faces a gaping deficit.
Nevada Medicaid agencies spent $244 million on optional programs last year. The total number of Medicaid recipients is expected to balloon in coming years to more than 200,000 from its current 164,800.
Gowins, Las Vegas resident Alice Thomas and other disabled advocates pressed lawmakers to approve another $4.5 million program allowing disabled people with middle-class jobs to keep their Medicaid benefits while cashing paychecks.
"People do want to go back to work," said Thomas, who returned to the job market last summer, seven years after suffering a nervous breakdown and slipping into depression.
Thomas, who has multiple sclerosis, lost Medicaid benefits for herself and two teenage children when she returned to work, and within months was $4,000 in debt due to health care and prescription drug costs.
No longer able to afford her apartment, she moved in with friends and away from her children.
"It was devastating," Thomas said. "I was trying to do something good for my family, and I broke us apart."
She now gets health coverage as a state employee but Willden said about 640 disabled people whose employers don't cover "pre-existing conditions" would benefit under the Buy In program. Similar programs exist in 14 other states.
Assemblywoman Sheila Leslie, D-Reno, worried that the program may be a "shift in philosophy" because recipients can be earning over $40,000 a year but still get benefits due to several income exemptions. Higher income recipients would pay back a premium to the state.
But Leslie and Sen. Raymond Rawson, R-Las Vegas, expressed support, saying they could tweak the program if it became too expensive.
Willden reminded lawmakers that Nevada ranks last among all states in Medicaid spending per resident, and cutting optional programs would mean losing millions in matching federal dollars.
"Most of them don't make sense to cut," he explained.
The Medicaid and Nevada Check-Up funding represents about half of the entire Department of Human Resources $1.3 billion request for state funds.
Willden detailed cost-saving measures within Medicaid programs, including a proposal to reduce amounts the state pays doctors who participate.
Nevada ranks fourth in Medicaid physician reimbursement, and Willden said he planned to huddle with the governor within days to determine whether reductions are in order.
Assemblyman David Goldwater, D-Las Vegas, suggested taking the opposite tack, and other lawmakers worried cuts could hurt availability of obstetricians in Southern Nevada.
"There is a crisis there," Rawson said. "It's pretty critical that we don't do anything to make that situation worse."
