Nevada spends about one-third of its general fund on public health programs like Medicaid and mental health services. But, in order to address a massive budget shortfall created by the response to the COVID-19 pandemic, lawmakers must cut around $233 million from public health services.
KUNR’s Lucia Starbuck looks into how this will impact Medicaid recipients and frontline workers.
Jennifer Cantley of Indian Hills is a mom of three young boys. She’s active in her community and coaches her sons in soccer, which can be difficult, considering all four of them have asthma.
She says before her family was enrolled in Medicaid, she would shell out hundreds of dollars a month just for the inhalers.
“I want to say they were close to $200 each because my insurance didn't really cover them that I had at the time," Cantley said. "I would just buy one inhaler and kind of have it for all of us. As a single mom, you know, making that decision and being in fear, no mother needs to go through that and I know more than just myself has had to make a choice like that. Do I pay the electricity bill or do I pay for my medicine?"
Cantley is just one of the roughly 688,000 Nevadans who use Medicaid, the public health coverage program for low-income Americans.
The Division of Health Care Financing and Policy is housed under the Nevada Department of Health and Human Services. Like every state agency, the department as a whole must reduce its $1.4 billion budget by 14 percent, as required by Governor Steve Sisolak.
That means, the Division of Health Care Financing and Policy is facing roughly $140 million in cuts.
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The proposed reduction includes cuts to several Medicaid services for adults, like capping physical therapy sessions, hospice services and dental care. The division may also have to completely eliminate optional services for Medicaid recipients, including optometry services, prosthetic services, private nursing, occupational therapy, chiropractic services and behavioral case management.
Those services are considered optional because the federal government does not require the state to provide them, but Department of Health and Human Services Director Richard Whitley says many Nevadans rely on them.
"By pulling some of these, what are federally considered optional services out, the impact, I can't sit here today and tell you because they're impacting individuals and what may be optometry or biofeedback may be a categorical service by itself but may have to be eliminated,” Whitley explained. “It may be of the cornerstone of service for that individual who has the need, and as a result of that service not being available, they may, in fact, require a higher level of need, or there may be an emergency room visit because of decompensation or of complications."
Like many other Nevadans, Cantley relies heavily on some of these services. Diagnosed with hydrocephalus - which causes fluid on the brain - she’s undergone five MRI’s just this year. Recently, her doctor told her she needed physical therapy and optometry services as part of her recovery. So far, Medicaid has covered those expenses, but Cantley says if they’re cut, she’s not sure what she’ll do.
"I feel like I can actually somewhat move and be somewhat human right now, but if I start losing these things that are helping me feel that way, it just scares me because then what kind of mother am I? I need to be active for my children,” Cantley said. “I'm their soccer coach. I'm usually out there, pushing them and playing with them and making them the best humans they can be in this world."
And that’s a concern for healthcare providers. About 36% of low-income adults have delayed treatment for a serious condition in the United States, according to a Gallup poll from last December.
"The likelihood of them needing more services in three months is going to be a lot higher, costing the state more money,” Cameron Duncan with the Nevada Advanced Practice Nurses Association said. “I think this approach to helping save the budget and, and kind of recover from the coronavirus, I understand it's importance, but doing it by cutting healthcare, isn't the best way, especially in a pandemic when people need to access healthcare services."
It’s not just individuals and families that’ll be affected. The cuts will also impact healthcare providers, mostly in the form of a 6% reduction to Medicaid reimbursements. In other words, the state will start reimbursing healthcare providers who treat Medicaid patients at a lower rate next month.
Duncan also runs his own clinic, Duncan Family Healthcare in Reno. He says if his office gets paid less money for the same services, he’ll have less money to pay staff, and may have to let someone go.
“It's [going to] make a cut to the number of people that I can see in a day in the office, not only with Medicaid insurance, but now my office wouldn't be able to maintain the current workflows because we will be down one less person," Duncan said.
Along with cuts to Medicaid, the governor’s proposal also includes eliminating nearly $20 million from the Division of Public and Behavioral Health, which oversees mental health services in the state.
Those cuts may limit the amount of money the state pulls in from the federal government, further compounding the impact on a state that already spends less on public health than almost any other.
For lawmakers on both sides of the aisle, the reductions are disheartening, but with a hole roughly a quarter of the state’s annual budget, there are only so many other places lawmakers can look to make adjustments.
Democratic Senate Majority Leader Nicole Cannizzaro says the cuts to public health are devastating.
"We're looking at some of these optional pieces of Medicaid and, I mean, optional hospice care doesn't sound optional to me. It is to Medicaid, but that's devastating,” Cannizzaro said. “And if you've ever had anybody who's been in that situation, I mean, I don't know how you make those kinds of cuts and don't have your heart just break for families who rely on those.”