Posts Tagged ‘Medicaid’

Gov. Sandoval Releases Expanded Budget Data

By Sean Whaley | 5:11 pm December 14th, 2012

CARSON CITY – Gov. Brian Sandoval today released budget data that had been sought by state lawmakers after a weeks-long disagreement over whether the information was public.

The state Budget Office posted the “items for special consideration” data on its website at noon. The items are requests made to Sandoval by state agencies for spending over and above their base-budget submissions. The base budget data was released by the Sandoval administration in October.

Gov. Brian Sandoval.

Included in the requests is a proposal to expand the Medicaid program to a new group of Nevada residents as provided for under the Affordable Care Act. As first reported by The Associated Press, Sandoval announced on Tuesday that he will propose expanding the program to provide health care coverage to 87,000 Nevadans, the cost of which will initially be paid for by the federal government. The 2013 Legislature will consider the recommendation.

Sandoval initially did not provide the additional budget information to the Legislature when it was expected on Oct. 15.

The decision prompted members of the Legislature’s Interim Finance Committee in late October to question state Budget Director Jeff Mohlenkamp about the decision.

Legislative Counsel Bureau Director Rick Combs told lawmakers that the information has been provided to lawmakers by past governors.

Mohlenkamp said the base budget data provided to the Legislature met the requirement of the state law on budget disclosure and Sandoval also defended the decision.

“There is no violation of law,” Sandoval said in October. “We’re perfectly consistent and in accordance with Nevada state law.”

The budget dispute was first reported by the Nevada News Bureau. The Las Vegas Sun also reported on the impasse earlier this month, which led to several calls in the media and by others for Sandoval to release the data.

Sandoval then announced last week he would release the budget data this week, which happened today.

Given the limited amount of state tax revenues, many of the special consideration items are not likely to see funding in Sandoval’s 2013-15 budget, which will be released next month ahead of the start of the Feb. 4 legislative session.

Many of the requests are for new positions. A total of just over 518 positions are in the agency wish lists for the first fiscal year, with about another 100 proposed to be added in the second year.

But there are other types of requests, such as the $20 million being sought from the general fund by the Governor’s Office of Economic Development to provide more money for the Catalyst Fund, which will be used to attract new businesses to the state. The Legislature created the fund in 2011 and appropriated $10 million for its operation in the current budget.

The total requests from the general fund by the various agencies total $419 million.

The Nevada Policy Research Institute congratulated Sandoval on releasing the budget information, but said the requests should be ignored because they are meaningless.

“That’s because they assume that every government agency should be given a substantial funding increase through costs – including pay increases – that automatically roll up,” said NPRI Deputy Policy Director Geoffrey Lawrence. “This outdated and broken budgeting process, commonly referred to as ‘baseline budgeting,’ failed to exact any accountability over the use of public resources.”

The adoption by the 2011 Legislature of a new process, called performance-based budgeting, which was advocated by NPRI, among others, will ensure the state’s highest priorities are funded, he said.

 

Medical Association Applauds Sandoval Medicaid Decision

By Sean Whaley | 11:11 am December 13th, 2012

CARSON CITYNevada State Medical Association President Florence Jameson said today that Gov. Brian Sandoval made a “politically courageous and correct” policy decision to expand the Nevada Medicaid program.

The decision will ensure that there will not be a new class of uninsured Nevadans when the federal health coverage changes are implemented in January 2014, said Jameson, a physician.

This decision assures coverage for low income uninsured Nevadans who would not be eligible for the new health insurance products provided through the Silver State Health Insurance Exchange. While controversial, the principal achievement of the Patient Protection and Affordable Care Act (PPACA) is the development of a complex scheme for providing health care coverage for most Americans, the announcement said.

The association recommended in September that Sandoval opt for the expansion, but Nevada physicians remain concerned that it does not improve the current Medicaid program, which is significantly underfunded, Jameson said.

The association “urges Governor Sandoval and the state Legislature to address the access to care needs of the patients who are, and will continue to be, covered by the current Medicaid program,” she said.

This medical care access issue is one reason the Nevada Policy Research Institute, a libertarian think tank, has criticized the decision.

NPRI Deputy Policy Director Geoffrey Lawrence said that because the Medicaid program systematically under-reimburses health-care providers, many are not taking new patients. This means current Medicaid enrollees – by definition the most vulnerable populations – will now be competing with healthy adults for fewer and fewer doctors. Sandoval’s decision will exacerbate the doctor shortages already faced by the children and the disabled who use Medicaid, he said.

“All this said, one must applaud the governor’s decision to finally institute consumer co-pays and thus introduce some real-world price sensitivity into the calculations of Medicaid consumers,” Lawrence said. “The primary reason for the health-care system’s high costs is the government-induced breakdown of the price system.”

Imposing co-pays is a proven way of encouraging individuals to seek only the care they really need, helping to control cost growth, he said.

Another concern cited by NPRI with the expansion is the increasing cost of the Medicaid program to taxpayers.

State Medicaid spending is already growing at an unsustainable pace and will soon displace K-12 education as the state’s largest budget item, Lawrence said. While Congress has pledged that federal taxpayers will cover a majority of costs for the newly eligible population through 2020, that will likely shift more to state taxpayers in later years, he said.

Sandoval Announces Intent To Expand Medicaid

By Nevada News Bureau Staff | 6:19 pm December 11th, 2012

CARSON CITY – Gov. Brian Sandoval today announced he will include 78,000 additional people in Nevada’s Medicaid program as provided for under the federal Affordable Care Act.

“Though I have never liked the Affordable Care Act because of the individual mandate it places on citizens, the increased burden on businesses and concerns about access to health care, the law has been upheld by the Supreme Court,” he said in a statement. “As such, I am forced to accept it as today’s reality and I have decided to expand Nevada’s Medicaid coverage.

Gov. Brian Sandoval.

“My fiscal year 2014-2015 budget will provide 78,000 additional Nevadans with health insurance coverage through Medicaid, which is estimated to save the state general fund approximately $17 million dollars in mental health savings,” Sandoval said. “My executive budget will also help Nevada businesses cope with the burden placed on them by decreasing the modified business tax. My decision to opt-in assists the neediest Nevadans and helps some avoid paying a health-care tax penalty. As part of my proposal, I will also call upon the Legislature to pass Medicaid patient responsibility cost-sharing measures.

“I will commit to working with the Legislature if anything changes at the federal level,” he said. “At any point during the Legislative session, if there is any sign of change at the state or federal level, it may alter my support for expansion.”

U.S. Sen. Harry Reid today praised Sandoval for his decision.

“This is wonderful for the people of Nevada and for the thousands of Nevadans who now will have health care,” he said. “I commend Gov. Sandoval for taking this bipartisan step. This is a win-win, it will save the state money, is good for the economy, good for employers and most importantly will help people. I worked hard to pass this legislation and I couldn’t be happier that the governor has made this decision.”

Gov. Sandoval Says He Has Complied With Budget Disclosure Requirements

By Sean Whaley | 1:11 pm October 26th, 2012

CARSON CITY – Gov. Brian Sandoval said today his administration has fully complied with a requirement in state law to provide preliminary state budget data to lawmakers and their staff.

“The agency requests have been presented to the Legislature in accordance with the law,” he said. “I don’t see any problems.”

Gov. Brian Sandoval.

Lawmakers on Thursday questioned state Budget Director Jeff Mohlenkamp on why some components of the initial agency request budget, known as “items for special consideration,” were not supplied to their fiscal staff as has been past practice. The items are funding requests beyond the agency base-budget requests for the 2013-15 spending plan. Expanding Medicaid to a new population of eligible Nevadans as allowed for under the Affordable Care Act is one such request.

Mohlenkamp said his office does not believe the special consideration items are part of the budget information required to be provided under Nevada Revised Statutes 353.211.

Sandoval said today the issue should not be characterized as one involving the transparency of his office.

“We are still gathering information on the Medicaid question,” he said. “We have not gotten all the instructions that we need from the federal government in order to completely prepare that. So anything that would be presented would not be complete at this time.”

Sandoval said his recommended budget will be made public in a “matter of weeks” and that release should satisfy lawmakers.

The budget is typically presented following the governor’s State of the State address in mid-January.

Sandoval said today it is unfair for anyone to suggest his administration failed to follow state law in the release of the budget data without providing any specifics about the alleged violation.

“There is no violation of law,” he said. “We’re perfectly consistent and in accordance with Nevada state law.”

Lawmakers expressed their concerns at a meeting of the Interim Finance Committee.

Rick Combs, director of the Legislative Counsel Bureau, said the additional budget information has been provided to legislative staff historically as specified in state law. It has also been made available to the public after being transmitted  to fiscal staff electronically by the state budget office on Oct. 15.

“The part that is of concern to us there is twofold,” Combs told the committee. “Your staff doesn’t have access to the information. The other concern is that information that is provided to us on Oct. 15 is supposed to be open for public dissemination at that point.”

Legislative Counsel Brenda Erdoes said Nevada statues, both 353.205 and 353.211, require the information to be provided to legislative fiscal staff. NRS 353.211 says in part that the information to be provided must include: “Each agency’s requested budget for the next 2 fiscal years.”

Assemblywoman Debbie Smith, D-Sparks, said at the meeting it is an ongoing issue that needs to be resolved.

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Audio clips:

Gov. Brian Sandoval says his administration has complied with state law:

102612Sandoval2 :05 see any problems.”

Sandoval says the Medicaid expansion issue is still not finalized:

102612Sandoval :13 at this time.”

 

Dispute Emerges Between Sandoval, Lawmakers Over Access To Budget Data

By Sean Whaley | 5:23 pm October 25th, 2012

CARSON CITY – A dispute has emerged between Gov. Brian Sandoval and the Legislature over what information in the initial state agency request budget should be made available to legislative staff and the public.

At a meeting of the Legislature’s Interim Finance Committee today, state Budget Director Jeff Mohlenkamp was asked about what is considered by legislative staff to be a departure from past practice regarding the budget information provided to legislative fiscal staff and the public.

The 2013-15 budget information conveyed to the Legislature on Oct. 15 does not include “items for special consideration” requested by state agencies. These items are budget requests from agencies that Sandoval will consider including in his final spending plan, but that have not yet been approved for inclusion by Sandoval.

Sandoval’s budget won’t be made public until mid-January.

Rick Combs, director of the Legislative Counsel Bureau, said this information has been provided to legislative staff historically as specified in state law. It has also been made available to the public.

LCB Director Rick Combs.

An example of an item of special consideration is the expansion of the Medicaid program to a new group of Nevadans as provided for in the federal Affordable Care Act. Sandoval has not made a decision on whether to expand Medicaid to this new group of Nevada residents.

Because of this apparently new interpretation by Sandoval, the Medicaid expansion information has not been provided to the Legislature’s fiscal staff and so is not available to the public either.

“The part that is of concern to us there is twofold,” Combs told the committee. “Your staff doesn’t have access to the information. The other concern is that information that is provided to us on Oct. 15 is supposed to be open for public dissemination at that point.

“Now if you, or a member of the public, asks us for anything that was in an item for special consideration, we don’t have it,” he said. “Even though we feel the statute requires that that to be available to you or a member of the public that ask for it.”

Combs said his staff  has asked for the information but has not received a response from Mohlenkamp.

IFC Chairwoman and Assemblywoman Debbie Smith, D-Sparks, asked Mohlenkamp for an explanation.

Mohlenkamp said a decision has not been made yet on whether to provide the information to legislative staff, and that the budget information transmitted to lawmakers has fulfilled the statutory obligation to lawmakers.

“We’re still considering whether we will be able to provide access to LCB fiscal,” he said. “That decision hasn’t been made. I’ve been in coordination with the governor’s office on this and I’m hopeful that we will be able to give a firm and final response in the near future. But right now that decision hasn’t been made.”

Mohlenkamp said there are all kinds of agency requests beyond Sandoval’s flat-budget guidelines that may not end up as part of the budget, and so should not be subject to speculation.

The change is significant enough that Geoff Dornan, the long-time capital bureau reporter for the Nevada Appeal, made a rare public comment at the meeting.

“We have always gotten the items for special consideration,” he said. “This change completely changes how the law has been interpreted, for longer than Mr. Mohlenkamp, no offense, has been working for the state.”

Sen. Ben Kieckhefer, R-Reno, also expressed concern, saying that if Sandoval decides not to propose expanding Medicaid to the new eligible population, then the budget data collected to provide background on this item of special consideration might never be provided to lawmakers or the public.

Kieckhefer said he would have a problem if that information was never made public.

Mohlenkamp said the Sandoval administration has not yet decided whether that information would be made public at some point.

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Audio clips:

LCB Director Rick Combs says the lack of budget data creates two concerns:

102512Combs1 :13 at that point.”

Combs says the LCB fiscal staff cannot provide information to lawmakers about the special budget requests because it does not have the information:

102512Combs2 :16 asks for it.”

Nevada Appeal reporter Geoff Dornan says the budget information should be made public:

102512Dornan :33 capital press corps.”

State Budget Director Jeff Mohlenkamp says  a decision has not been made on whether to provide the information to legislative staff:

102512Mohlenkamp :21 hasn’t been made.”

 

 

 

Nevada Agencies Request $6.46 Billion In New Budget, Up $279 Million From Current Spending Plan

By Sean Whaley | 1:02 pm October 15th, 2012

CARSON CITY – Nevada’s next two-year general fund budget would grow by $279 million to $6.46 billion based on the initial spending requests submitted by state agencies, information released today by the Budget Division shows.

State Budget Director Jeff Mohlenkamp, who will continue to piece together Gov. Brian Sandoval’s final recommended 2013-15 budget through at least December, said the increase in spending is due primarily to the growing public education and Medicaid populations. The public education piece is estimated at $18 million. The Medicaid population increase is expected to cost $104 million.

State Budget Director Jeff Mohlenkamp. / Nevada News Bureau file photo.

The budget is still subject to a variety of revisions by Sandoval between now and January when it is released to the public and lawmakers. The final budget will depend greatly on available tax revenue, which will be set by the state Economic Forum in early December.

“We’re wrestling quite a few different variables that all have to be factored in before ultimately those decisions are made,” Mohlenkamp said.

The agency request budget also includes the cost of expanding Medicaid to already eligible Nevada residents expected to enroll in the program because of the federal Affordable Care Act. This piece is expected to cost $86.6 million.

The budget does not include an expansion of Medicaid to a newly eligible group of Nevadans provided for under the health care law, Mohlenkamp said. Sandoval has yet to make a decision on that issue, he said.

“We have decision units prepared, that should the governor make the decision to opt in, then we can very quickly make that happen within the budget,” Mohlenkamp said.

The budget does anticipate the continuation of several tax increases that are now set to sunset on June 30, 2013. It also, for now, continues salary reductions and furloughs for state workers that would save approximately $160 million.

Sandoval has said he will consider restoring some of the reductions if general fund revenues are sufficient to do so.

Geoffrey Lawrence, deputy policy director for the Nevada Policy Research Institute, praised Sandoval and his budget staff for helping state agencies limit their spending increases.

“While not perfect, these agency budget requests are a concrete step toward limiting the growth of government from already inflated levels,” he said. “Besides limiting spending increases, this budget shows the power of performance-based budgeting, which focuses on providing the highest level of outcomes for every dollar spent.”

Lawrence also warned lawmakers against using any higher revenue projections from the Economic Forum to boost spending.

“Higher-than-expected revenue projections from the Economic Forum should be used to lower taxes on struggling Nevada families, instead of as an excuse to increase government spending,” he said.

Mohlenkamp said the spending numbers released today are expected to be within the general fund tax estimates set by the Economic Forum.

“We do believe that we are in the range, but we don’t know how close we are to actually what the Economic Forum will come in at,” he said. “But that’s pretty much of an unknown right now.”

The final budget will be the first to comprehensively include performance-based budgeting, Mohlenkamp said. The process is expected to make the budget more transparent so the public can easily understand where the money is being spent. It will also provide better accountability on whether the state is achieving its goals, he said.

Several major initiatives being proposed in the budget include a restructuring of the Division of Mental Health and Developmental Services, with the mental health side going to the Health Division, and the developmental services piece going to Aging and Disability Services.

“It’s a fairly major restructuring that is going on within Health and Human Services,” Mohlenkamp said.

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Audio clips:

Budget Director Jeff Mohlenkamp says Gov. Brian Sandoval has not yet made a decision on expanding Medicaid:

101512Mohlenkamp1 :25 decision on that.”

Mohlenkamp says the state’s tax revenues remain an unknown until the Economic Forum meets:

101512Mohlenkamp2 :19 unknown right now.”

 

 

Poll Finds Nevadans Divided On New Tax Proposal But Strongly Favor Education Reform Efforts

By Sean Whaley | 11:08 am September 26th, 2012

CARSON CITY – The results of a poll of Nevada residents conducted on behalf of the Retail Association of Nevada (RAN) show that 45 percent of those queried believe a 2 percent margins tax on business proposed by teachers will generate the revenues necessary to support public education.

But 49 percent say the new levy, if approved, would raise prices, increase the state’s already high jobless rate and hurt business, according to the poll by Public Opinion Strategies of 500 likely voters taken Sept. 19-20. It has a margin of error of 4.38 percentage points.

Photo courtesy of the National Archives and Records Administration via Wikimedia Commons.

And when asked if money alone will improve Nevada’s public education system, only 22 percent agreed, with 73 percent saying the system also needs significant reforms.

The Nevada State Education Association is currently circulating petitions to take the proposed new tax to the Legislature in 2013, but a legal challenge to the proposal remains alive in Carson City District Court.

The poll found that 59 percent of those surveyed said the amount of taxes they pay is about right, with 22 percent saying taxes are too high.

And 58 percent said the governor and Legislature should raises taxes if necessary to avoid cuts to education and health care, while 32 percent said spending should be cut instead.

RAN began conducting the semi-annual poll in 2009, and many of the questions have been asked each time. In this way, the poll can give not only a snapshot of current conditions, but it can also identify trends by comparing results from earlier polls.

Poll information is then shared with RAN members, the public and state legislators so that the concerns of our state will be considered when policies are shaped in Carson City.

Among the other findings in the latest survey:

- Gov. Brian Sandoval is popular, with 62 percent approving of his job performance. But only 45 percent say the governor understands their problems, and only 33 percent say the Legislature does.

- A majority of those surveyed, 52 percent, say the state should not freeze the defined benefits offered to public employees through the state retirement system, while 41 percent say a freeze should be implemented to save money.

- The survey found that 48 percent of respondents believe that Nevada should opt into the Medicaid expansion provided for under the Affordable Care Act, while 44 percent say the state should opt out because of the cost and because the neediest residents are already covered.

- Asked about the conservative Tea Party Movement, 26 percent of respondents said they had a strongly or somewhat favorable view of the movement, with 35 percent saying they have strongly or somewhat unfavorable views.

Public Opinion Strategies (POS) is a national political and public affairs research firm. Founded in 1991, POS has conducted more than five million interviews with voters and consumers in all fifty states and over two dozen foreign countries.

State Medical Association Supports Expansion Of Medicaid Eligibility Under Affordable Care Act

By Sean Whaley | 1:35 pm September 13th, 2012

CARSON CITY – The Nevada State Medical Association has announced it supports expanding Nevada’s Medicaid caseload as permitted under the federal Patient Protection and Affordable Care Act (PPACA).

The association’s board of directors met on Sept. 8 and adopted the policy statement, which was based on the information currently available about the expansion of the Medicaid program.

Photo by Debora Cartagena/CDC.

“We believe that this is necessary to assure that there is not a new class of uninsured Nevadans created by a gap in the PPACA coverage plan,” said the statement by the association, released Wednesday.

“Nevada physicians are concerned that this does not improve the current Medicaid program, which is significantly underfunded,” the statement said. “Current payment levels have made it increasingly difficult for physicians and hospitals to maintain their availability for Medicaid patients. This has become particularly true for children with disabling conditions or chronic illnesses and for women facing high-risk births.”

As a result, the association said it is urging Gov. Brian Sandoval and the Legislature to “address the access to care needs of the patients who are, and will continue to be, covered by the current Medicaid program.”

The Nevada State Medical Association is Nevada’s oldest and largest physician advocacy organization.

The authorized Medicaid expansion is still under review by the Sandoval Administration. If recommended by Sandoval and approved by the Legislature in 2013, it would take effect on Jan. 1, 2014 for Nevadans up to 138 percent of the federal poverty level. The potential caseload expected under such an expansion is still being analyzed.

Federal funding would pay for 100 percent of any Medicaid expansion for the first three calendar years beginning in 2014, with the state required to pick up a percentage of the cost beginning in 2017. The first year state cost is 5 percent, in 2018 the state cost is 6 percent, in 2019 the state cost is 7 percent, and in 2020, the state cost is 10 percent.

The expansion in Nevada would mostly cover childless adults who are not covered by the state program now.

Nevada is already moving forward with its Silver State Health Insurance Exchange, which will offer eligible residents the opportunity to purchase health insurance beginning on Oct. 1, 2013.

Meanwhile, data from the U.S. Census Bureau shows that Nevada’s uninsured population continues to increase. While the rate nationally declined by 0.5 percent to 16 percent between 2008-09 and 2010-11, Nevada’s rate increased 2.7 percent in that same time period, to 22 percent.

Federal Agency Says States Can Expand, Later Reduce Medicaid Under ACA

By Sean Whaley | 12:26 pm August 7th, 2012

CARSON CITY – States do not face any deadline for deciding whether to expand their Medicaid coverage under the Affordable Care Act, and will be able to expand coverage and then later chose to reduce it, federal officials told Governing magazine on Monday.

Cindy Mann, deputy director for the Centers for Medicare and Medicaid Services, made the comments at a National Conference of State Legislatures meeting in Chicago.

Photo by Debora Cartagena/CDC.

The article by Dylan Scott with Governing magazine also had comments from a CMS spokesperson confirming that states can chose to expand eligibility and later choose to reduce it, the first public confirmation that CMS will make such an option available.

Nevada Gov. Brian Sandoval is still assessing whether to expand Nevada’s Medicaid eligibility as a result of the June ruling by the U.S. Supreme Court upholding most of the federal health care law. The court struck down the provision allowing the federal government to penalize states if they did not opt into the Medicaid expansion.

The optional expansion to cover those at 133 percent of the poverty level is set to take effect Jan. 1, 2014.

Sandoval’s initial comment was that the state could not afford to undertake any expansion under the law. But he is awaiting additional information and clarification from the U.S. Department of Health and Human Services before deciding how to proceed.

Federal funding will pay for 100 percent of any Medicaid expansion for the first three calendar years beginning in 2014, with the state required to pick up a percentage of the cost beginning in 2017. The first year state cost is 5 percent, in 2018 the state cost is 6 percent, in 2019 the state cost is 7 percent, and in 2020, the state cost is 10 percent.

The expansion in Nevada would mostly cover childless adults, who are not covered by the state program now. The other expansion will come from parent caretakers of children who are covered at 75 percent of poverty now, according to Mike Willden, director of the Nevada Department of Health and Human Services.

Willden said last month there are also administrative costs to the state that are not fully covered by the expansion but instead are shared between the federal government and the state at a 50-50 match. They include information technology costs and the cost to hire new eligibility workers, for example, he said.

Willden said in May  that as many as 150,000 additional Nevadans would be eligible for Medicaid if the law was upheld by the court, but that estimate was two years old and was made before the court said states could opt out of the expansion.

He estimated that bringing new residents onto the rolls would cost the state general fund an estimated $574 million between now and 2020.

But only $63 million of that cost estimate was due to the Medicaid expansion. The rest was due to those Nevadans who are already eligible for Medicaid but who have not enrolled. This population is expected to enroll in the program as a result of the mandate to obtain insurance.

 

Gov. Sandoval Says Many Questions Must Be Answered Before Medicaid Expansion Decision Can Be Made

By Sean Whaley | 2:28 pm July 13th, 2012

CARSON CITY – Gov. Brian Sandoval said today he needs a lot of questions answered before he can decide whether to expand Medicaid eligibility in Nevada, and that it could take several months to resolve all the uncertainties.

“There’s no specific time schedule,” he said. “I mean I understand right now we’ve had the Supreme Court decision. Everyone has been waiting for that. I think there are still people that are trying to interpret it.

Gov. Brian Sandoval. / Nevada News Bureau file photo.

“There’s still a question within the law regarding the penalty provision,” Sandoval said. “That if a state, whether it ops in or opts out, whether it is still subject to some type of a penalty. Although the federal government can’t withhold all of your Medicaid money there is still an outstanding question about whether it can withhold some of it.”

The U.S. Department of Health and Human Services has to interpret the U.S. Supreme Court ruling upholding most of the Affordable Care Act and answer the many questions before a decision can be made in Nevada, he said.

“The answers to those questions will have a lot to do with how we’re going to estimate the expenses in this state,” Sandoval said. “So it’s premature right now. We’re doing the best that we can with the information that we have. And once I have that information then I can make an informed decision.”

State officials are busy preparing information on what expanding Medicaid to 138 percent of the federal poverty level, as proposed in the health care law, would cost Nevada. The information should be in Sandoval’s hands within two weeks. But having that information does not mean that Sandoval will be ready at that time to make a decision.

The federal government will pick up most of the cost of an expansion for the first several years, but there will be costs to the state as well.

Sandoval also said Nevada decided in the 2011 legislative session to establish its own health care exchange under the law, and that the process of doing so is moving forward. This despite the fact that a $72 million contract sought by the Silver State Health Insurance Exchange to create the information technology needed to operate the exchange beginning Oct. 1, 2013, was delayed today.

The contract with Xerox State Healthcare was scheduled for a vote by the Board of Examiners, including Sandoval, but was pulled because the board overseeing the Exchange was unable to approve it on Thursday.

Six dozen Republican members of Congress have called on the nation’s governors not to implement the exchanges, arguing they add to the cost of doing business. Several governors, including Rick Perry of Texas, who is in Nevada today campaigning for Mitt Romney, have said they won’t move forward with establishing an exchange.

“My biggest concern as I’ve said all along is that I don’t want the federal government coming to the state of Nevada running our exchange,” Sandoval said. “This is a state issue that we should be handling. We have a great board. We have a great director. And we’re going to move in accordance with the law.”

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Audio clips:

Gov. Brian Sandoval says there is no timetable to make a decision on expanding Medicaid:

071312Sandoval1 :12 to interpret it.”

Sandoval says questions remain, including the penalty provision for opting out of a Medicaid expansion:

071312Sandoval2 :17 some of it.”

Sandoval says that when he has all the information he can make an informed decision:

071312Sandoval3 :24 an informed decision.”

Sandoval says Nevada needs to run its own health exchange:

071312Sandoval4 :13 with the law.”

 

 

 

State Officials Crunching Numbers For Gov. Sandoval To Make Decision On Medicaid Expansion

By Sean Whaley | 3:22 pm July 12th, 2012

CARSON CITY – Nevada officials are busy preparing cost and enrollment estimates so Gov. Brian Sandoval will have reliable information before deciding whether to expand Medicaid following the U.S. Supreme Court ruling last month upholding much of the Affordable Care Act.

But even if Sandoval does not expand Medicaid to 138 percent of the federal poverty level as provided for in the law, the program is expected to grow significantly as Nevadans who are now eligible but not enrolled decide to sign up when the health insurance mandate takes effect on Jan 1, 2014.

The effective date is in the middle of the first year of the upcoming two-year budget now being prepared by the Sandoval administration. The Legislature will take up the budget, and the Medicaid issue, when the 2013 session starts in February.

State officials are readying data for Sandoval to make a Medicaid decision

Mike Willden, director of the Department of Health and Human Services, and state Budget Director Jeff Mohlenkamp, are gathering the data to show the anticipated effects on the state budget of these two distinct Medicaid groups.

“Our goal is to have the numbers over to the governor by the end of next week,” Willden said. “We’re just not ready to give out numbers yet and I don’t want to give out bad numbers. There are 10 moving parts.”

Mohlenkamp said the court threw everybody “a bit of a curve,” when it decided states do not have to opt into an expanded Medicaid program.

State Budget Director Jeff Mohlenkamp. / Nevada News Bureau file photo.

“So we’re now in the process of analyzing what that looks like, the pros and cons of that, the financial impact on the state of the options, and, is it absolutely straightforward; you either opt in or opt out,” he said. “Or are there other options within the Supreme Court ruling that we can consider.”

Sandoval’s initial response was to reject an expansion

When the Supreme Court said the federal government could not penalize states if they do not choose to opt into the Medicaid expansion, Sandoval’s initial comment was that the state could not afford to do so. But he is awaiting the information before deciding how to proceed.

“This is going to be a governor’s office decision,” Mohlenkamp said. “The governor will make the decision as to the policy of the state going forward. He has not yet made that decision. He’s looking for a very critical analysis of what the options are and the pros and cons for the state.”

The bigger cost to the state general fund will likely come from those eligible but not enrolled in Medicaid, because the state share of adding those individuals is projected to be 38 percent in 2014, compared to a 62 percent share from the federal government.

This cost to the strapped state budget will occur whether or not an expansion is approved by the Nevada Legislature.

All of the analysis is dependent on the implementation of the federal health care law. Republican members of Congress and GOP presumptive presidential nominee Mitt Romney want to repeal the law.

Federal funding will cover most, but not all, of a Medicaid expansion

Federal funding will pay for 100 percent of any Medicaid expansion for the first three calendar years beginning in 2014, with the state required to pick up a percentage of the cost beginning in 2017. The first year state cost is 5 percent, in 2018 the state cost is 6 percent, in 2019 the state cost is 7 percent, and in 2020, the state cost is 10 percent.

But Willden said there are also administrative costs to the state that are not fully covered by the expansion but instead are shared between the federal government and the state at a 50-50 match. They include information technology costs and the cost to hire new eligibility workers, for example, he said.

State Health and Human Services Director Mike Willden / Nevada News Bureau file photo.

“And so we’re trying to again cost out for the governor, clear through 2020, because there are state costs involved in those out years even though everybody says it’s 100 percent federal the first three,” Willden said. “There are state costs in the out years, there are also state costs associated with the administrative costs for the new eligibles.”

There will be some savings because mentally ill people now being treated by the state at full cost to the state general fund will be Medicaid eligible, and there will be some savings to the counties because they now use county general fund money to pay for medical care for individuals who would become Medicaid eligible, he said.

The counties are analyzing that potential impact, Willden said.

Another question that is being researched with federal officials is whether the opt-in option would require a full commitment to the 138 percent of poverty level, of if some lesser level could be pursued, he said.

“The goal is to try to get all of this to come together in the next couple of weeks,” Willden said. “That way the governor would have enough information to at least review on the opt in, opt out opportunity.”

Medicaid expansion would cover new groups, including childless adults

If Medicaid is expanded in Nevada, new participants will be childless adults, who are not covered by the state program now, Willden said. The other expansion will come from parent caretakers of children who are covered at 75 percent of poverty now.

Medicaid now covers primarily low-income children, the disabled, pregnant women and seniors. These groups are now covered at different poverty rates ranging from 100 percent to 138 percent.

State lawmaker concerned about long-term financial implications of an expansion

State Sen. Ben Kieckhefer, R-Reno, who will be involved in the Medicaid issues in 2013 as a member of the Senate Finance Committee, said Sandoval is taking a prudent course because there are so many unanswered questions given the Supreme Court’s surprise decision allowing states to opt out of the expansion.

A critical question is what happens with the generous federal funding after 2020 and as Congress and the President grapple with unsustainable spending on federal programs, he said.

“It is a very good deal in the first couple of years,” Kieckhefer said. “I mean the feds pay 100 percent of the medical costs for the first three years. That’s a great deal. It then goes down to 90 percent after the fifth year. And there is nothing that mandates that that goes on forever.

“So I think the stronger concern is, how does the federal government continue to justify paying 90 percent of those costs as it’s trying to deal with the massive federal deficit and reducing that deficit,” he said. “And I think that there is a strong likelihood that eventually the feds start shifting that cost burden back to the states and that’s a risk that the state needs to weigh.”

Assembly Ways and Means Chairwoman Debbie Smith, D-Sparks, said her plan is to have an overview of the court ruling from staff at the Legislature’s Interim Finance Committee on Aug. 23.

“I want to just make sure that we have a really good understanding of what all the possibilities and ramifications are,” she said. “I want that to be the first informational piece and then we can go from there.”

Nevada’s health insurance exchange is another factor in the complex review

Another variable in the assessment is the Silver State Health Insurance Exchange now being readied in Nevada where residents will be able to shop for health insurance beginning Oct. 1, 2013. Nevadans between 100 percent and 400 percent of the federal poverty level will be eligible for subsidies when they purchase insurance.

The ACA rules appear to indicate that if Medicaid is not expanded, Nevadans who would have been covered in an expansion could go to the Exchange and receive a tax credit as long as all other requirements are met.

The Exchange is gearing up now with federal funds, but the state will have to pick up the cost of its operation when federal grants run out in 2015, Willden said.

Another issue is whether there are enough doctors and other medical providers to offer services to an expanded population, he said.

Willden said in May that as many as 150,000 additional Nevadans would be eligible for Medicaid if the law was upheld by the court, but that estimate was two years old and was made before the court said states could opt out of the expansion.

He estimated that bringing new residents onto the rolls would cost the state general fund an estimated $574 million between now and 2020.

But Kieckhefer said only $63 million of that cost estimate was due to the Medicaid expansion. The rest was due to those already eligible who were expected to enroll as a result of the mandate to obtain insurance.

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Audio clips:

Mike Willden of Nevada Health and Human Services says his agency is trying to estimate the cost of a Medicaid expansion program through 2020:

071212Willden1 :22 the new eligibles.”

Willden says the goal is to get the data to the governor in the next couple of weeks.

071212Willden2 :13 opt out opportunity.”

State Budget Director Jeff Mohlenkamp says the pros and cons of a Medicaid expansion are being analyzed:

071212Mohlenkamp1 :19 we can consider.”

Mohlenkamp says Gov. Brian Sandoval will make the call on a Medicaid expansion but that he has not done so yet:

071212Mohlenkamp2 :16 for the state.”

State Sen. Ben Kieckhefer says he is concerned about the potential long-term financial obligation to the state:

071212Kieckhefer :26 reducing that deficit.”

 

Republican Candidates For New 4th Congressional District Focus Mostly On Issues In Debate

By Sean Whaley | 8:39 pm May 21st, 2012

CARSON CITY – Three of the Republicans seeking the right to challenge state Democratic Senate Majority Leader Steven Horsford for Nevada’s new 4th Congressional District seat sought to establish their conservative credentials in a televised debate today.

Barbara Cegavske, in the middle of her final four-year term in the state Senate, Danny Tarkanian, who has run for elective office on several occasions including a campaign for the U.S. Senate in 2010, and Dan Schwartz, a businessman and attorney fresh to the political arena, are seeking a victory in the June 12 primary to advance to the November general election.

In a televised debate on the Face To Face television program, the candidates took the opportunity to sell themselves  voters.

The debate was fairly subdued, without any real fireworks among the three candidates.

The sharpest attack came when Schwartz’s television ad was aired, which criticized Tarkanian for running repeatedly for a “taxpayer funded” job. Schwartz called himself a job creating businessman and a constitutional conservative in the spot.

Dan Schwartz.

“The question is, he’s run three times and Nevadans have said they’ve considered it, they just haven’t pulled the lever,” Schwartz said in commenting on his ad.

Cegavske said she would examine the federal budget line-by-line to find savings in an effort to achieve her campaign goal of cutting $1 trillion in federal spending in her first year in office. The U.S. Department of Education would be the place to start with the Commerce Department second, she said.

“You can go through all the agencies, and if you start looking through each one, you bring that money back to the states, give block granting, and you can cut administration,” she said.

Tarkanian offered some specifics on what he would do if elected, pointing to flaws in the Endangered Species Act and potential protections for the Sage Grouse that are stifling job growth in Nevada.

“Everywhere I go in rural Nevada, everywhere I go in the Mesquite area, they complain that if you are on BLM (Bureau of Land Management) land and you want to get a mine started, if you want to do anything on BLM land, it takes seven to 10 years to get it processed through the federal government,” he said.

Danny Tarkanian.

The same process takes three to five years at the state level, Tarkanian said.

“Why does it take almost twice as long in the federal government when Nevada needs jobs. We should make it easier for people to get permitted,” he said.

Tarkanian also said his proposal for tax fairness means eliminating tax loopholes and tax breaks and lowering the income tax rate for average Americans.

The three candidates agreed with Gov. Brian Sandoval that Internet purchases should be subjected to the state sales tax. Sandoval recently reached an agreement with Amazon to collect the tax on Nevada purchases. Their positions conflict, however, with U.S. Sen. Dean Heller and Rep. Joe Heck, both R-Nev., who oppose the so-called Main Street Protection Act.

The three candidates agreed for the need to repeal the federal health care law, but they also argued that worthwhile elements, such as providing coverage to those with pre-existing conditions, should be continued independently.

Tarkanian said his biggest concern with the law is the cost to the state’s Medicaid program, which cannot be afforded. The health care system can be strengthened by allowing health insurance to be purchased across state lines and by providing for the portability of health insurance plans, he said.

Cegavske said the law has to be repealed in its entirety as the first step.

Barbara Cegavske.

“And anything that is salvageable or people think is good then you can bring those issues back,” she said. “We don’t have the money to pay for Obamacare.”

Schwartz said repeal is necessary although there are some elements worth preserving such as letting children stay on their parents insurance through age 26.

Then the real problems have to be addressed such as how hospitals are paid, he said.

“Another real problem is that we as Americans all feel entitled to health care,” Schwartz said. “And we just can’t continue with a system that just says you can get whatever you want.”

Tarkanian is leading in the fundraising race for the primary, while long-time state lawmaker Cegavske has been endorsed by Nevada’s two GOP Congressional representatives: Mark Amodei and Joe Heck. Cegavske served with both men in the state Senate.

The Republican candidate faces a challenge in the district, however, newly created as a result of the 2010 census. The district, which includes parts of urban Clark County and much of central rural Nevada, has a Democratic voter edge.

Through April, there were 111,978 active Democrats registered in the district, compared to 89,182 Republicans, for a 44 percent to 35.1 percent for Republicans. There are also 39,273 nonpartisan voters.

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Audio clips:

Sen. Barbara Cegavske says federal spending can be slashed using block grants:

052112Cegavske1 :18 cut his budget.”

Cegavske says Nevada cannot afford the federal health care law:

052112Cegavske2 :12 pay for Obamacare.”

Candidate Dan Schwartz says Danny Tarkanian has failed to win the support of Nevada voters in past campaigns:

052112Schwartz1 :05 pulled the lever.”

Schwartz says federal health care costs must be curtailed:

052112Schwartz2 :27 whatever you want.”

Candidate Danny Tarkanian says federal permitting rules need to be streamlined:

052112Tarkanian1 :24 to get permitted.”

Tarkanian says the federal health care law will bankrupt the state:

052112Tarkanian2 :16 health care system.”

 

Medicaid Caseload Will Expand By 150,000, Cost Nevada $574 Million if Federal Health Care Law Is Implemented

By Sean Whaley | 2:51 pm May 7th, 2012

CARSON CITY – The head of Nevada’s Department of Health and Human Services said today that as many as 150,000 more residents will be eligible for Medicaid coverage if the federal health care law is found constitutional by the U.S. Supreme Court.

Bringing new residents onto the rolls is expected to cost the state an estimated $574 million between now and 2020, said HHS Director Mike Willden in an interview on the Nevada NewsMakers television program broadcast today.

The estimate, which is about two years old, includes the cost to the state of serving new Medicaid eligibles, the cost of new information technology needed to implement the law and some increased payments to primary care physicians, he said.

The U.S. Supreme Court is expected to rule on the constitutionality of the health care law by June.

U.S. Supreme Court.

Nevada was one of more than two dozen states to challenge the constitutionality of the new law. Even so, Gov. Brian Sandoval has moved forward with implementation because it is the law of the land.

Willden said the new rules say that every man, woman and child living under 138 percent of the federal poverty level will be eligible for Medicaid, the cost of which is shared by the states and federal government.

“Our estimate in Nevada is, as I indicated, we have about 325,000 people on Medicaid or our Checkup program now, and we may see upwards of 150,000 more people eligible for Medicaid,” Willden said. “Because we pick up a group that we’ve never covered in Nevada, and that’s what we call childless adults. Nevada has never served childless adults.”

The other part of the expansion will come as Nevadans now eligible for Medicaid but who have not enrolled in the program will participate because of the individual mandate to have health insurance, he said.

Willden said he does not believe Nevada’s medical provider community will be able to accommodate the increased population seeking health care.

“As you know we’re one of the worst in the nation when it comes to primary care physicians ratios to population, specialists of various kinds ratios to population, and you bring in many, many more on Medicaid I don’t think there will be what we call adequate networks to provide that, so that will be a challenge,” he said.

Nevada will need to bring more physicians into the state, but will have to compete with other states to do so, Willden said. It could also lead to an examination and potential expansion of what types of medical care nurses and physician assistants are able to provide to patients, he said.

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Audio clips:

DHHS Director Mike Willden says about 150,000 more Nevadans may be eligible for Medicaid:

050712Willden1 :22 served childless adults.”

Willden says Nevada’s medical community may not be able to handle the increase in the Medicaid eligible population:

050712Willden2 :23 be a challenge.”

 

Gov. Sandoval Will Extend Sunsetting Taxes Into Next Two-Year Budget To Avoid Education Cuts

By Sean Whaley | 2:17 pm March 13th, 2012

CARSON CITY – Gov. Brian Sandoval said today he will propose to extend a package of taxes now set to expire in June 2013 into the next budget to avoid further cuts to education, which he said cannot withstand further reductions.

To maintain a basically flat spending plan for the two-year budget that will begin on July 1, 2013, Sandoval said the modified business tax that was maintained at a higher rate for large businesses in the 2011 legislative session, along with a small increase in the sales tax, must be continued.

Gov. Brian Sandoval. / Nevada News Bureau file photo.

The 2011 tax package also eliminated the business tax for 115,000 small Nevada businesses which would continue into the next budget as well.

“We’re going to keep them,” Sandoval said of the sunsetting taxes. “Again, my baseline is this: I’m not going to cut education, and that includes K-12 and higher ed. I am not going to reduce services for the most vulnerable people in our society.

“I’m not going to pit kindergartners against senior citizens,” he said. “I’m not going to pit higher ed students against people that need essential services.”

This preliminary recommendation for beginning the budget process for the 2013 legislative session could be modified as the state’s fiscal picture becomes clearer in the coming months, Sandoval said.

“We’re going to be having many conversations between now and when the final budget is presented to the Legislature,” he said. “I believe at this point in time, which is very early, it is the responsible thing to do for the future of the state of Nevada.”

Sandoval said an expanding Medicaid caseload, along with costs associated with the expansion of the program under the federal health care law, will consume any revenue increases. Because of this, failing to include the sunsetting taxes for budget planning purposes would mean cuts to education.

“In addition to avoiding further cuts to education, this decision means there will be no need for tax increases in the next session,” Sandoval said. “Nevadans will pay no more than they are in the current biennium. The budget building process remains ongoing, but we must begin today.”

Efforts are under way to circulate petitions to put possible tax increases before the voters, including measures that could lead to hikes in both mining and gaming taxes. A gross margin tax on business is also being considered by labor groups and teachers but no ballot measure has been filed yet.

Sandoval made the announcement to the capitol press corps after a meeting of the Board of Examiners. He said his intention with the announcement is to be transparent.

Sandoval strongly opposed continuing the tax increases approved by the 2009 legislature in the 2011 session, but ultimately agreed to do so after a Nevada Supreme Court ruling threw his proposed budget into financial disarray.

The 2013-15 budget planning process begins Thursday with a briefing by state Budget Director Jeff Mohlenkamp to state agencies and representatives of public and higher education.

Today’s announcement was immediately welcomed by some Republican lawmakers.

Sen. Michael Roberson, R-Las Vegas, who is expected to lead the Republican Senate caucus in the 2013 legislative session, said he supports Sandoval’s preliminary budget instructions.

“I support Gov. Sandoval and his budget instructions that will not impose new taxes on the people of Nevada,” Roberson said. “I will continue to lead the fight against new tax increases while working with Gov. Sandoval to improve public education. I will not support additional cuts to public education.”

Roberson opposed extending the sunsetting taxes in the 2011 session, arguing that the Nevada Supreme Court ruling did not create the huge financial hole in the budget that others had suggested.

“Gov. Sandoval has outlined a prudent and fiscally responsible preliminary budget framework,” Roberson said.  “I am grateful for his tremendous leadership. I will stand with him and support him.”

Sen. Ben Kieckhefer, R-Reno, announced his support for Sandoval’s proposal via Twitter.

“I applaud the decision by Gov. Sandoval to do what is necessary to protect education from cuts,” he said, adding that what that means in the 2013 session is yet to be determined.

Nevada Senate Democrats issued a statement saying they “applaud” the change of position by Sandoval and Republican lawmakers but that the proposal is an insufficient short-term fix.

“What we need are long-term solutions to resolving our budget problems, not postponing them for another 2 years,” said Sen. Mo Denis, D-Las Vegas. “We must address tax fairness for middle class families, cut wasteful spending in our government, and provide Nevada business with an educated workforce that can help compete in the national and global marketplace.

“In order to diversify our economy and attract new businesses and industry to Nevada, we must show them we are serious about investing in a well educated workforce,” he said. “We can’t do that if education funding remains stagnant.”

Geoffrey Lawrence, deputy policy director at the Nevada Policy Research Institute, criticized Sandoval’s announcement in a statement:

“Taxpayers lose again with Gov. Brian Sandoval’s decision to propose extending the so-called ‘sunset’ taxes,” he said. “This demonstrates, once again, the danger behind the concept of a ‘temporary’ tax increase. Once bureaucracy becomes dependent on that additional revenue to sustain itself, the tax increase rarely goes away.

“In 2010, Gov. Sandoval stated that raising taxes is ‘the worst possible thing you can do’ after a recession,” Lawrence said. “His statement is as correct today as it was then – raising taxes on job creators is exactly the wrong thing to do in the aftermath of a recession.”

Sandoval said the spending will also be prepared using the new approach of performance-based budgeting.

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Audio clips:

Gov. Brian Sandoval says he will keep the sunsetting taxes in his budget to avoid cuts to education:

031312Sandoval1 :14 in our society.”

Sandoval says he won’t pit kindergarteners against senior citizens:

031312Sandoval2 :12 need essential services.”

Sandoval says at this point in time it is the responsible thing to do:

031312Sandoval3 :12 state of Nevada.”