Lawmakers endorse Medicaid managed-care plan

Relying on advice from its legal counsel, the Legislative Committee on Health Care has endorsed a statewide Medicaid managed-care program.

The program, scheduled to take effect Oct. 1, would require that Medicaid patients throughout the state abandon the present fee-for-service system -- where they chose a doctor of their choice -- and sign up with a health maintenance organization.

But Committee Chairman Sen. Raymond Rawson, R-Las Vegas, emphasized that community providers, such as University Medical Center, must be included in whatever program is established.

"It is our intent to see that you (UMC) are protected," Rawson said at Friday's meeting at the Grant Sawyer State Office Building in Las Vegas. "We expect the agency (state Division of Health Care Financing and Policy) to set up procedures to monitor HMOs, so they negotiate in good faith."

Assemblywoman Jan Evans, D-Sparks, said the Legislature five years ago approved a Medicaid managed-care program. She said she couldn't understand why the committee was grappling with the same issues again.

"I wasn't elected to rely on someone else's judgment five years ago," Assemblywoman Barbara Buckley, D-Las Vegas, said. "How do you protect those who continue to provide care, and suddenly they are faced with loss of Medicaid dollars?"

Bill Hale, chief executive officer at UMC, had expressed concerns at previous committee meetings that as a county hospital, his facility could lose lucrative Medicaid patients. The hospital then would only be treating indigent people, he said, and the county would lose a source of revenue.

Hale, however, said he felt assured that UMC wouldn't be sidestepped in the new Medicaid managed-care program.

"I believe, at this time, going forward is probably the most prudent thing to do," Hale said. "Hearing that essential community providers won't be harmed is reason to go forward into the next century -- monitoring as we go along."

The committee also voted to eliminate an assets screening test for parents applying for Medicaid's Children's Health Assurance Program (CHAP).

The state is scheduled to begin its own Nevada Check UP program on July 1 that would expand health insurance to an estimated 69,000 poor children. This program doesn't require an assets evaluation, relying only on household income.

The Health Care Financing Administration (HCFA) informed the state that it needs to promote "seamlessness" between the two programs before it approves the Nevada Check Up plan.

The committee approved a proposal to remove the assets test for CHAP, and to inform HCFA of Nevada's policy change.

It's still uncertain, however, whether Nevada Check Up will begin on time.

To date, Christopher Thompson, administrator for the state Division of Health Care Financing and Policy, said only 4,293 children have applied for the Nevada Check Up program.

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