Nevada's Medicaid program is facing an unknown this year that will make it tough for the 2005 Legislature to plan for the future of the program that serves the poor, disabled and elderly.
President Bush will unveil in the coming months his changes - most likely cuts - to the federal-funding side of Medicaid. With less government money, Nevada and other states will either have to pick up the slack or reduce the number of people the program serves.
"We don't know how much" will be cut, said Joy Johnson Wilson, health care director for the National Council of State Legislatures. "But we're not expecting a very good year this year."
Wilson said every state faces a crisis. To make do with available federal money, they'll have to limit eligibility or reduce services or reimbursements to providers.
In Nevada, that will be difficult since most of the people served by Medicaid fall into groups that must be covered under the law.
Over the next two years, Gov. Kenny Guinn has proposed $837 million in state Medicaid spending, more than half of the human services budget. That's up 28 percent, from $653 million, since the last legislative session.
Still, Nevada lags behind, said Charles Duarte, the state's Medicaid administrator.
"We have a minimal program," he said. "We are 51st in Medicaid spending per capita nationwide. We don't spend a lot of tax dollars on a lot of people."
Medicaid, which covers 50 percent of the long-term care in the United States, is essentially "unsustainable in its current form," Duarte said.
Duarte said the Nevada's caseload will grow to nearly 223,000 by fiscal 2007, up from the 177,000 currently served.
In addition to the state funds, counties and school districts will contribute $410 million and the federal government will offer an anticipated $1.5 billion, about 55 percent.
But Bush may decided that the federal government will cap its contribution in the future by providing states with block grants, or lump sums, instead of matching state money and growth. This year, said Duarte, the federal government puts in 55 cents of every dollar spent, with the state providing 45 cents.
