Las Vegas Sun

January 22, 2018

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County raises stakes in effort to push state to agree to return millions

Cut in county allotment to Medicaid match program will cost state $8.4 million

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If the state had only played fair last year, what transpired quietly during a recent Clark County Commission meeting might never have happened.

Instead, commissioners recently voted to cut the county’s annual allotment that enables the state to gain tens of millions of dollars in additional matching funds from the federal government to help offset the cost of Medicaid payments.

County officials say cutting the allotment to about $42 million annually from $50.4 million doesn’t hurt the chance of getting federal matching dollars. It does, however, diminish by more than 50 percent the amount that the state has traditionally “skimmed” off the top of that money for “administrative” costs, said George Stevens, Clark County’s financial chief.

The skim has grown over the years, so much so that after administrative costs are paid the state uses the rest of the money to pay for Medicaid in counties outside of Clark County — even though Clark County supplies nearly 100 percent of the money needed to obtain the federal matching dollars, Stevens said.

Chris Giunchigliani

Chris Giunchigliani

County Commissioner Chris Giunchigliani said Clark County was being used as the cash cow for the rest of the state.

“We’re essentially subsidizing the rest of the costs for other counties,” she said.

But that wouldn’t be such an issue, she also said, if the state had only worked with the county to return some of the money the state had taken three years ago. The county contends a 2011 Nevada Supreme Court ruling in a case brought by the Clean Water Coalition requires that the state return about $102 million it had collected from the county.

Don Burnette

Don Burnette

For seven months, County Manager Don Burnette has been talking to the governor’s office to try to work out a compromise. Sources said the county was even willing to take just $25 million at $5 million a year for five years.

But the governor’s office dug in its heels and refused.

“We asked Don to work out some compromise, even if it wasn’t the full dollar amount,” Giunchigliani said. “That was commenced for months and months and has gone nowhere.”

In June, the county filed a lawsuit to force the state to pay. Then commissioners agreed to cut the county’s allotment for the Medicaid program.

Mike Willden, director of the state Department of Health and Human Services, said he hoped the state and county still could talk about the matter.

“At some point in time, we’ll have to find a solution. It’s not a cash-flow train wreck for us, or for them. At some point, it may be,” he said. “Cooler heads should prevail.”

Or, county officials say, the state needs to give in and hand back to Clark County at least some of the $102 million because there is no denying that money and the lawsuit were going through the minds of county commissioners when they voted a week ago to cut funding to the state for the Medicaid/matching program.

If the vote stands and isn’t reconsidered, it means the state stands to see its “skim” this year fall $8.4 million, from $16 million to about $7 million. At the same time, however, the county will see its net benefit increase by $9.5 million, going from $33.8 million to $42.3 million, Stevens said.

The kicker is that even though the county contribution declines, the real beneficiary of the federal dollars, University Medical Center, will get the same amount of money through the Medicaid/matching program.

UMC will still receive about $84 million — equal to the $42 million Clark County submitted to the feds plus another $42 million the feds give as matching funds. The reason for that is when the matching funds program began in 2002 — the state came to Clark County for the matching money because it said it didn’t have enough on its own — the county gave money upfront to the state for administrative expenses, even before the state received federal matching dollars.

Now the county is simply cutting that upfront “donation.”

Steve Sisolak

Steve Sisolak

“Seven million dollars should be more than enough for the state’s expenses to administer this program,” Commissioner Steve Sisolak said.

Willden isn’t giving up on the chance that the county might reconsider.

“I understand Clark County feels like it’s overpaying,” Willden said. “We want to provide Medicaid. Hopefully, we can find a middle ground.”

Giunchigliani said the county “will play, but we’re not going to do it at the expense of UMC and our taxpayers.”

“We want to cover the state’s administrative costs,” she added, “but this isn’t something they should be making a profit from.”

University Medical Center operates at annual loss of about $75 million, despite the fact that Clark County puts about $150 million into it annually.

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