Locals protest cuts to Medicaid

Local officials on Wednesday protested human services cuts in the governor's proposed budget they say will cost counties nearly $50 million a year.

The biggest piece reviewed is a change in the Medicaid long-term care funding formula local officials say will cost them $20 million a year.

Medicaid provides long-term care beds for those unable to take care of themselves. The reductions are made by changing the complex formula for determining state funding for those Medicaid recipients in long-term care facilities. Under the current formula, the state, federal money and local governments share the cost of caring for those disabled people.

Charles Duarte, administrator of Health Care Financing and Policy, told a joint Senate/Assembly subcommittee the long-term care change saves the state $37 million over the biennium.

"A county cannot pay more than its budget," said Mary Walker, lobbyist for Carson, Douglas, Lyon and Storey counties. "We'd be deciding whether to lay off police and firefighters or kick these people out of their beds. That would be a terrible choice."

Lyon County Manager Jeff Page said the change would cost Lyon County $565,000 and force the layoff of eight public safety employees.

Bobbie Gordon of Clark County said that jurisdiction has 900 long-term care clients costing a total of $34 million during the biennium.

"Please consider the impact and serious consequences," she told lawmakers.

Carson City, according to a spreadsheet released by the Nevada Association of Counties, would lose $817,947 a year to the change in long-term care funding. Manager Larry Werner said before they can determine the actual annual impact, they have to sit down with Duarte's people and better understand exactly how that formula works. He said there were some indications counties might be able to reduce the impact some how.

Altogether, a spreadsheet prepared by county officials shows Carson City would lose $2.36 million just in fiscal year 2013.

Officials pointed out those aren't the only cuts they are facing. There also are cuts or elimination of state funding to a dozen other human services programs including the mental health courts, rural developmental services tuberculosis and sexually transmitted disease programs, child protective services, juvenile justice programs and county youth camps among others.

Association of Counties Executive Director Jeff Fontaine told the committee he thinks the state's estimates are low, that when all those other cuts are added in, local governments stand to lose $49.7 million in just Fiscal 2013.

He said the burden is complicated by the fact the long-term care costs can be made up with property taxes, but some counties are unable to use that source. He said Mineral County, for example, would lose $216,000, which would require a 22-cent property tax increase. White Pine County, he said, would need a 17-cent property tax hike.

But Fontaine said since both those counties are at the statutory $3.64 property tax cap, neither can raise their rate even a penny, leaving them no alternative but to cut services elsewhere.

To add to the damage, Fontaine said the $50 million total doesn't even include the state plan to again sweep the Indigent Accident Fund, a $25 million a year hit to counties. That fund pays hospital bills of indigents who suffer catastrophic injury in accidents.

According to county officials, Douglas County would take a $1.16 million hit, $310,984 from long-term care costs and Churchill a $707,233 cost, $206,540 from long term care.

The subcommittee chaired by Sen. Sheila Leslie, D-Reno, took no action on the proposals. She said more hearings will be held on Medicaid and the other proposed human services cuts before any decision is made.