Nevada governor urges feds to protect Medicaid funding amid concerns of deep cuts

Gov. Joe Lombardo is urging Congress and the Trump administration to refrain from slashing Medicaid funding, warning that cuts to essential programs alone “will not solve Washington’s spending problem or the rising cost of health care.”

Lombardo, in a letter Wednesday to Nevada state legislators, said he was “actively engaged in conversations” with the White House and federal officials about Nevada’s concerns over Medicaid, which provides health coverage for roughly 1 in 5 Americans, most of them poor. The cost of the program is shared by federal and state governments, although the lion’s share of funding is picked up by Washington.

“An abrupt reduction in federal funding would not only disrupt care for those who rely on Medicaid, but would also destabilize public and private healthcare providers, leading to workforce reductions, service limitations, and financial strain on already overburdened health care facilities,” Lombardo, a Republican, said in the letter.

President Donald Trump, a fellow Republican, has promised not to cut Medicaid, except in instances where waste, fraud and abuse are found, but congressional Democrats have been sounding alarm bells since the Republican-controlled House of Representatives put forth a budget resolution that serves as a blueprint for enacting the president’s agenda.

The resolution, which passed with all but one Republican vote Tuesday night, directs the committee that oversees Medicaid to come up with $880 billion savings through 2034.

Congressional Republicans are hunting for cost-cutting measures to pay for a signature feature of Trump’s agenda: $4.5 trillion in tax cuts. With military spending cuts off the table, the next biggest pot of money available is the nation’s health care programs, including Medicaid.

The Nevada Department of Health and Human Services projects cuts nationally on the $880 billion scale could cost Nevada nearly $1.9 billion in federal Medicaid funding over the upcoming biennium. Some 800,000 Nevadans rely on Medicaid.

On Wednesday night during a meeting of the joint Legislative Committee on Health and Human Services, Brett Salmon, president and CEO of Nevada Health Care Association — which represents assisted living and nursing facilities staffing over 13,000 employees — talked about uncertainty of any actual cuts.

“We have a national association that is very directly involved in negotiations, very involved with leadership on both sides of the aisle,” Salmon said. “I spoke with them this week and almost every question that I asked them the answer was ‘I don’t know.’”

State legislators sought answers from Salmon and others from the public health sector during a nearly three-hour hearing. They found Nevada could face serious implications with changes to the Medicaid program.

Nevada DHHS has considered some possible scenarios for cuts to the program, but director Richard Whitley told lawmakers, “We don’t know yet” what Congress’ end game will be.

“We have a fragile health care system that we do have to work through all the time when changes occur at a federal level,” Whitley said. “And it doesn’t benefit us to have people be fearful when we don’t have a known.”

The House’s plan seeks to extend Trump’s 2017 tax cuts and increase spending by up to $90 billion on Homeland Security to assist in paying for mass deportations through 2034.

Congressional Republicans are seeking to use a legislative process known as reconciliation, which would allow them to push through a federal budget and avoid any filibusters by Senate Democrats.

Both chambers would need to agree on the legislation to make that happen. But doing so is complicated by the fact that the Senate adopted its own budget framework. The Senate passed its resolution in a 52-48 vote last week. It would also bolster Trump’s agenda and authorize roughly $340 billion in spending that includes billions for immigration-related efforts.

“Obviously, they have to come together and have an agreement,” said Rep. Susie Lee, D-Nev., at an event in Las Vegas on Friday. “And right now, the plan is, President Trump wants to pass this package, which will include devastating cuts.”

The House voted Tuesday in favor of its budget resolution, 217-215, with no Democrats in support. Next up is for House and Senate Republicans to work out differences in their respective resolutions, which could be challenging with a group of House Republicans wary of deep cuts to Medicaid. Any further GOP defections in the House would imperil passage of the final legislative package.

Among the handful of Nevada’s options if there are Medicaid cuts include reductions for “optional” services only; every state has benefits it’s mandated to provide under federal law, accompanied by the optional benefits the states can choose to add. Nevada’s optional benefits include prescription drugs, personal care and diagnostic, screening and rehabilitation services.

“We don’t take out an entire service,” said Nevada Medicaid administrator Stacie Weeks in response to a legislator’s concern about the potential reduction. “We’d have to look to see (the cost of) prescription drugs ... maybe what’s not life and death, but those are kind of the conversations we can’t really go to until we have more information about what we would need to do.”

The possibility of Medicaid cuts shouldn’t be a concern only for Democrats, said state Sen. Fabian Doñate, D-Las Vegas.

“Disease does not discriminate based on your racial identity or your political party. It does not care what your political identification is,” Doñate said. “It affects all of us, and so we need to remember that when people enroll into Medicaid, it’s not because people are taking advantage of the system.”

Lombardo told state legislators one point he expressed to federal leaders and “areas of greatest concern for the state” included possible rollbacks on expansion funding, which has mitigated Nevada’s previously high uninsured rates.

That expansion came when former Republican Gov. Brian Sandoval adopted it, extending Medicaid eligibility in Nevada to nearly all adults under 65 years of age with income at or below 138% of the federal poverty level in 2014, according to a state Division of Health Care Financing and Policy fact book.

Expansion rollbacks could result in a $988.9 million impact on the state general fund for the 300,000 Nevadans who may face a loss of coverage. The federal government currently uses a formula called Federal Medical Assistance Percentage (FMAP) taking a state’s income into account to determine the federal government’s share of Medicaid funding with each state.

For Nevada’s expansion population, the match currently is 90%, meaning that for every dollar the program costs, Nevada pays 10 cents and the federal government pays 90 cents, Weeks said. That could be bumped down to near the traditional 50%.

“If you can’t fill that hole, or we don’t find ways to make cuts to address it, it would impact coverage and our ability to pay for medical services for that 300,000 people,” Weeks said to the Nevada lawmakers.

Republicans have criticized Democrats’ concerns about cuts, pointing in part to Trump’s promise to leave Medicaid untouched.

“I would like to assure the public not to panic and not worry, the sky is not falling,” said state Sen. Jeff Stone, R-Henderson, at a news conference. “The joint Health and Human Services hearing is premature, a political theater and a waste of staff resources.”

Cindy Goussak, executive director for Collaboration Center Foundation, a Las Vegas disability services network, told the Sun “without question” there’s a new level of fear among clients as the current presidential administration gets to work.

“Now it’s not just the concern of how to navigate, but the fear that there won’t be anything to navigate,” Goussak said about the program. “And then what are their choices? These individuals cannot afford to go on to the open market and get insurance, so then they just will not be getting health care.”

Doñate said Medicaid cuts after June that could negatively affect a balanced state budget would require a special session and a presentation from Lombardo on reductions from programs the state can no longer afford. “That’s why it’s important for all of us to stand unified against these cuts,” Doñate said. “And for the Republicans that have relationships with the Trump administration, they need to leverage those relationships to say these cuts are going to affect Nevadans negatively.”