Health officials paint grim picture under Gibbons’ plan

By Cy Ryan

Friday, Jan. 23, 2009 | 2:36 p.m.

CARSON CITY – County hospitals could close, the state could receive $14 million in federal sanctions and rural Nevadans could be left without mental health treatment, according to a grim assessment of Gov. Jim Gibbons’ social services budget delivered Friday.

The State Department of Health and Human Services would receive a 4 percent funding increase, but the state is seeing an increase in demand for services from low income families, said department Director Mike Willden, who outlined the $2 billion budget for the legislative budget committees.

Assembly Speaker Barbara Buckley, D-Las Vegas, noted that in this budget there would be an additional 5 percent reduction to Medicaid reimbursements to hospitals to care of indigent people. There has already been a 5 percent cut.

Buckley said the reductions could cause hospitals to close, leave abused children without treatment and eliminate surgeries for children with heart problems.

“The system is collapsing,” Buckley said.

The state is also stripping a $55 million indigent accident fund that pays the hospitals mostly for those low income people injured in auto accidents.

Willden told the committees that the $55 million will be moved to the Medicaid program to qualify for an additional $60 million in federal funds. He said the Medicaid program would lose $110 million if the indigent accident fund is not tapped.

Assemblyman Pete Goicoechea, R-Elko, said the cost of caring for accident victims will fall to the counties. Counties and cities are also getting hit financially in other areas as the state tries to deal with its budget shortfall.

The state Division of Welfare and Supportive Services could be penalized by the federal government for failing to meet the standards in handling cases within a deadline. Romaine Gilliland, administrator of the division, said there was a potential of $14 million in sanctions from the federal government. But he said a $5 million penalty would be more likely.

The welfare numbers are expected to go up 40 percent as the poor state and national economies continue.

Federal inspectors this month were at the Flamingo Road welfare office in Las Vegas and the waiting line was three hours.

“We’re being watched by the federal government,” Gilliland told the Senate Finance Committee and the Assembly Ways and Means Committee.

The federal government wants 95 percent of welfare applications processed within 45 days, he said. The state now is at 85 percent.

The welfare budget calls for hiring 400 more workers to handle the increased caseload. It provides $10.8 million to create an electronic system for people to apply for welfare assistance.

Buckley questioned whether there were innovations that might eliminate the need to hire an additional 400 workers. She said once the economy improves those extra workers might not be needed.

There will also be major cuts to the budget of the state Division Mental Health and Developmental Services, calling for the closure of 11 mental health clinics in rural Nevada and reducing the staff at the Rawson-Neal mental hospital in Las Vegas.

Shutting down 11 of the 21 clinics in rural Nevada will “completely destroy” the system in the counties outside Clark and Washoe, said Assemblywoman Sheila Leslie, D-Reno. She said the individuals in need of treatment will not travel to other cities with clinics and “they will end up in local jails and prison.”

“This is completely unacceptable,” Leslie told Division Administrator Harold Cook.

He said the division is talking about transporting these patients to other cities or hiring private psychiatrists in the rural areas.

Cook told the committees the staff at the Las Vegas hospital will be reduced by 96 employees. He added, “I’m comfortable we still will be able to maintain quality service.”

At the Las Vegas hospital, the ratio is 2.4 full time employees per bed. A survey of private and public hospital in the West show the range was 1.2 full time employees to 2.1 employees to a mental health bed.

With the cut, the ration would be 2.1 employees per bed, still among the highest in the West, Cook said.

The mental health clinic in North Las Vegas was closed last year because of a lease dispute but there was a plan to reopen it at another location. Cook said with the budget cuts, the North Las Vegas clinic will be permanently closed.

The division opened a clinic in downtown Las Vegas which is only about one mile from the former North Las Vegas clinic, Cook said. And the majority of the clients went there and to other clinics in Clark County.

“With this budget, mental health is going backwards,” Leslie said.

Cy Ryan may be reached at (775) 687 5032 or [email protected].