Caring for Nevadans as Our Economy Changes

This week our state unveiled a bold vision for economic development. Moving Nevada Forward: The State Plan for Excellence in Economic Development is our blueprint for how we will get Nevada working again. In releasing this plan, I challenged the businesses and people of Nevada to create 50,000 jobs in the next three years. And we pledged to continue to build on the our successes in education reform and other areas. However, much remains to be done. Thousands of Nevadans are dependent on critical social service programs, and we must address these needs even as we grow the economy.

Medicaid and other Health and Human Services caseloads have grown exponentially in recent years. Some of this growth is due to the economic downturn; some is due to new federal requirements. Early estimates indicate that federal legislation passed by the Obama administration may cost Nevadans nearly $600 million between 2014 and 2019.

We are responding. The state is pursuing more managed care options to control costs and still provide essential services. And we are doing everything we can to meet the needs of those who rely on us to meet their very unique challenges. I am proud to say that Nevada is meeting both challenges - improving efficiency while providing the necessary quality of care.

One example is in the area of programs that keep Nevadans out of long-term care facilities and living on their own. We preserved millions of dollars for these programs in the current budget, despite significant reductions that had to be made in overall spending. Nevada is continuing to find ways to ensure we provide the least restrictive level of care.

Nevada leads the nation in its vision to and success in enabling people with intellectual and developmental disabilities to receive the attention and medical care they need in a comfortable environment. According to a 2011 United Cerebral Palsy analysis, Nevada ranks first in its ability to provide needed services in a person's own home, a family home, or in a setting with only 1 - 3 other residents. Nevada ranks eighth in the Nation in its overall ability to provide community-based support to this population.

In addition, according to a 2010 external evaluation conducted to assess Nevada's compliance with the Americans with Disabilities Act community integration mandate, Nevada is described as "one of the leaders in the country in minimizing unnecessary institutions." The community integration mandate was determined by a U.S. Supreme Court decision known as Olmstead, which gave clarity that people with disabilities, both mental and physical, have the right to receive needed services away from institutions in a community-based setting.

As one of Nevada's responses to the Olmstead decision, the state created the Facility Outreach and Community Integration Services program, first piloted in 2002 and made available statewide in 2004. The ability for Nevada Medicaid to provide community-based services was recently enhanced with a $10 million grant from the Centers for Medicare & Medicaid Services that provides funding for an individual and follows him or her through the levels of care. CMS recognizes and supports Nevada's continued effort to transition individuals out of unnecessary institutional long-term care settings, and into home or group home settings.

Essential to Nevada's success in providing an appropriate level of care in the community is the Medicaid waiver program. Waivers are focused programs which have targeted purposes and are jointly funded by CMS, Division of Health Care Financing and Policy and the Division of Mental Health and Developmental Services. These waivers offer our state's Medicaid program additional flexibility to determine how elderly, physically and developmentally disabled clients receive care.

The combination of supporting both in-home and residential options has produced a substantially balanced long-term care program. In spite of the increase in numbers of people calling Nevada home, and a growing number of elderly in our state, the number of Medicaid-paid nursing home days has remained level.

I am extremely proud of the hard work our Department of Health and Human Services staff and community integration partners have done to develop and implement programs which not only provide better care delivery to some of our most vulnerable citizens, but also have created program efficiencies which help all Nevadan save money by not paying for unnecessary nor unneeded institutional services.

At my core, I believe the best service we can provide is to put Nevadans back to work. But we must also minimize suffering, ensure that Nevadans live in dignity, and help those who need it most. It is a difficult balancing act in this economy, to be sure. But it is a commitment we are intent on keeping.

* Nevada Gov. Brian Sandoval can be reached through his website gov.nv.gov.