No decisions yet on Medicaid cost sharing

No decision has been made on how Medicaid recipients will be asked to share in the costs of their care, and state administrators warned lawmakers Wednesday they’ll likely be grappling with the issue in the waning days of the legislative session.Health and Human Services Director Mike Willden told members of the Senate Finance and Assembly Ways and Means committees that while Gov. Brian Sandoval’s budget assumes Medicaid recipients contribute $3 copayments for doctor visits, the figure was a place holder while proposed federal regulations released last month are reviewed.Willden said a public comment period on the proposed regulations ends Thursday, and it could be weeks before final rules are adopted, leaving legislators little time to implement a plan.Other programs, such as the Nevada Checkup insurance program for children, require families to pay quarterly premiums. Willden noted that is another option to be considered for Medicaid recipients.Some lawmakers were uncomfortable with charging the poor a copay to see a doctor.“These are very poor people,” said state Sen. Debbie Smith. “The perspective is important. We’re talking about people who make very little money.”Assemblywoman Lucy Flores, D-Las Vegas, agreed. She said she’s not opposed to asking people to contribute to their care if they can afford it. “But let’s ask ourselves, can a family of four really afford it,” she said.Under the federal health care law, Nevada’s Medicaid enrollments are projected to swell from 313,000 to about 490,000 by 2015. The increasing caseloads include people who are currently eligible but not enrolled, and those who are expected to sign up as eligibility thresholds are expanded to meet a mandate to have health insurance.The Patient Protection and Affordable Care Act also increases the rates primary care physicians receive for treating Medicaid patients. Those rates took effect Jan. 1, but insurers must sign up and attest that they are primary care providers by March 15 to receive payments from the start of the year.“They will not get retroactive supplemental payments if they don’t enroll by March 15,” Willden said.Those rates, however, do not extend to doctors who treat Nevada checkup patients, another program that insures children through 18 years old who don’t qualify for Medicaid. The governor’s budget is proposing about $800,000 from the state general fund to equalize doctor rates for the two programs over the next two years beginning July 1.Some lawmakers questioned if Nevada will have enough Medicaid providers to handle the expected influx of new patients as the health care law is implemented.“We are all going into a huge unknown period here in about nine months,” Willden said.Another challenge of the federal health care law is how to smooth the transition of people whose income levels may fluctuate at the Medicaid eligibility threshold.People who are at or below 138 percent of the federal poverty level will receive health care under Medicaid. For an individual, that amount is $15,856 per year. The threshold for a family of four is $32,499.If their eligibility changes, Willden said his agency will work with administrators of the Silver State Health Insurance Exchange to try to find them private insurers and try to make sure patients don’t lose their primary care providers in the transition.The Silver State Health Insurance Exchange is scheduled to begin taking enrollments Oct. 1 for coverage that begins Jan. 1, 2014.Willden said trying to coordinate all the various aspects of implementing the law is a daunting challenge.“We’re drinking from a fire hose,” he said. “It’s pretty rapid stuff right now.”