State cuffed by money: A case in point

By J. Patrick Coolican

Sunday, March 8, 2009 | 3 a.m.

This is a story of how poverty can be expensive, for both Nevada and its people.

A bill in the Legislature would make it easier for the disabled to get treatment, and for their health care providers to get paid.

In the long run, it would nearly pay for itself.

But the state has no money to get it started, so, sorry.

More than 31,000 Nevadans on Medicaid, the federal-state health program for the indigent and disabled, are what’s known as “SSI eligible.” This means they were automatically eligible for Medicaid because the federal Social Security Administration had determined they deserve Supplemental Security Income, which goes to the poor who are disabled, blind or 65 or older.

Essentially, everyone agrees these impoverished people should also get health care.

The problem is that often the federal government takes months to determine whether a person is SSI-eligible. And until he is judged SSI-eligible, he can’t join the Medicaid rolls.

Dwight Hansen, a health care finance analyst at the Nevada Hospital Association, said member hospitals say the process averages 10 months but can take longer.

What happens if one of these people gets sick in the meantime?

Medicaid patients struggle to find treatment in the valley because many physicians refuse to take Medicaid, often because payment is delayed while the clinic and the patient wade through the federal bureaucracy.

So, many patients live with pain and sickness until finally being hospitalized. Federal law requires the hospital to give treatment. But the payment doesn’t arrive until SSI eligibility is determined, either.

So here’s the fix, which has been done in other states and which everyone — Republicans, Democrats — agrees would be smart policy: “Preliminary determination.”

Given that most people eventually are determined to be SSI-eligible, the idea is to get them on the Medicaid rolls now so they can be treated quickly and the providers can be paid faster.

The change wouldn’t cost much because by law Medicaid pays retroactively — once the person is on the rolls, his treatment since applying for SSI is paid for.

Though some people would eventually be found ineligible or disappear, in other cases there would be some savings to Medicaid because prompt treatment can save money — without, they wind up in expensive emergency room care at the county hospital.

An upfront cost does exist, however, a one-time shift forward in time of payments. It’s as if your company changed its payday from the second Friday of the month to the first Friday, so that first time it would pay twice in three weeks instead of the usual four.

Fiscal analysts have determined the cost for Nevada would be $38 million over the biennium.

Chuck Duarte, who administers Medicaid for the state, said he expects the number to be revised downward because to remain in federal compliance the state would have to have some rigor in its own preliminary approval process.

Regardless, lawmakers and others agree that this is a good idea at a fairly minimal cost.

“Absolutely it’s good policy,” said Assemblywoman Sheila Leslie, a Reno Democrat and vice chairwoman of Ways and Means. “Most people are eligible and it gets them on the program quicker and the feds pick up roughly half the cost. They get the services they need and the hospitals don’t eat the cost.”

But she laughed bitterly about the upfront cost. “We couldn’t find our way to do it in good times.”

So it likely won’t happen this year.

Sick people will struggle to get treatment, and cash-strapped hospitals, especially the county hospital, will wait months to get paid.

Yes, it seems poverty can cost dearly.