Help for badly disabled promised, still not delivered

CARSON CITY, Nev. - More help for badly disabled Nevadans, promised months ago by the Guinn administration, still hasn't materialized, prompting complaints from activists and a request from legislators for some action.

Just before lawmakers adjourned the 1999 session last May, they were told a combination of state and federal Medicaid funds would be used to help another 30 severely disabled people this fiscal year, followed by 30 more in the coming fiscal year.

But the current fiscal year is half over, and about 200 people are still on a waiting list for such benefits.

About 165 Nevadans now benefit from a waiver that allows them to earn between $500 and $1,500 a month without being cut off from Medicaid benefits that help them to avoid institutions or other highly restrictive living arrangements.

"We did all these things to make this work, always keeping costs in mind - and we sit here today with little or nothing done," says Paul Gowins, an advocate for the disabled who's confined to a wheelchair.

"It's simple procrastination," adds Mary Jean Thomsen of the Northern Nevada Center for Independent Living. "Nobody is pushing this waiver along."

Thomsen blames Janice Wright, head of the state Division of Health Care Financing and Policy, who told lawmakers last spring that services for the physically disabled could be expanded without having to drastically revamp the existing Medicaid waiver program.

"She promised that more people would come out of nursing homes," said Thomsen. "These people keep hearing it. But there's a lack of moving anything along. It's more months out of their lives."

The delays and the complaints from Thomsen, Gowins and others prompted the Legislature's interim subcommittee on health care to send Gov. Kenny Guinn a letter at the start of the New Year urging action.

"A lot of time has gone by," says Assemblywoman Ellen Koivisto, D-Las Vegas, chairwoman of the subcommittee. "These people were promised things in 1997 that they didn't get, and they were promised things again in 1999."

The physically disabled waiver program is a small part of a $500 million-a-year Medicaid program run by the state. The expanded services authorized by the 1999 Legislature added about $1 million to that budget.

While the cost is up, Gowins said the hope was to show that the waiver program would save a lot of money in the long run by getting more people out of institutions.

Asked to comment, Wright said a draft of the waiver expansion has been completed and has gone to her boss, state Human Resources Director Charlotte Crawford. She didn't want to comment further, deferring to Crawford.

Crawford said she wasn't making excuses, but added Wright's office was held up by staff turnover and other tasks. Crawford got the waiver proposal just after Christmas.

Now that the draft has been delivered, Crawford added, "It still needs some fine-tuning." But she said it should be submitted by mid-December to the federal government for approval.

Controversy over the waiver predates the 1999 legislative session: Lawmakers in 1997 had approved another type of waiver and had allotted $500,000 for it. But nothing was done and the money was reverted last year.

HRD and the state Department of Employment, Training and Rehabilitation had been charged with completing the earlier waiver application but didn't get the job done, lawmakers were told.

The Legislature also was told that Nevada spends less money than any other state to keep its residents out of nursing homes.

Researchers said Nevada ranked at or near the bottom in overall Medicaid money spent on alternatives to institutional care, long-term care spending and home and community-based services.

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