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March 24, 2017

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Potential Medicaid privatization affecting elderly, disabled worries advocates

Marsha Rodriguez considers the home caregiver who visits her five days a week a lifeline.

Rodriguez, 72, suffers from a hereditary protein deficiency that makes it difficult for her to breathe. She needs oxygen and has limited mobility because of several herniated discs.

As a recipient of a Home and Community Based Waiver, which uses Medicaid funding, Rodriguez receives services from a home caregiver who helps her bathe, dress and accomplish small tasks such as doing laundry or cutting vegetables.

What this means: Rodriguez can continue living at home rather than in a nursing home. “I feel blessed to have this program,” Rodriguez said this week at a Nevadans for the Common Good meeting.

Members of the nonpartisan group of faith-based organizations and nonprofits worry that Medicaid recipients who are elderly, blind or disabled may be in danger of losing services if the state transitions the population to a Medicaid managed care program.

The Aging and Disability Services Division operates waiver programs that provide nonmedical services to elderly, blind or disabled people who otherwise wouldn’t be able to remain living at home.

An Assembly bill that proposed shifting this population to Medicaid managed care died in committee without a public hearing, but similar language was tacked onto the final appropriations bill in the most recent legislative session. The law permits the state to implement Medicaid privatization for this population.

It’s unclear whether the proposed change would affect all Medicaid recipients who are elderly, blind or disabled or just the subset of that population who receive nonmedical services through waiver programs, said Jane Gruner, administrator for the Aging and Disability Services Division. The division supports three waiver programs that serve 4,443 people.

Nevadans for the Common Good — which has tackled issues of community concern such as sex-trafficking in the past — addressed the proposed Medicaid change during a meeting on Tuesday. Several hundred members attended, along with more than a dozen Nevada lawmakers, including state Sen. Michael Roberson and Assemblymen Paul Anderson and John Hambrick.

“We are extremely concerned about how privatization would affect access to services, potential gaps in service and the quality of service for these vulnerable populations,” said Barbara Paulsen, a member of the Boulder City United Methodist Fellowship. “Nevada’s social safety net and system is very fragile and already has gaps in service.”

Advocates fear the move to Medicaid managed care would result in stricter eligibility requirements and reduced services for people like Rodriguez. They also object to what they call the state’s lack of transparency during the planning process, holding internal meetings without giving stakeholders — service recipients, providers and community advocates — a seat at the table.

“Any change to the system that doesn’t increase capacity or access is very dangerous for both the economy and the fabric of our society,” said Jeffrey Klein, president and CEO of Nevada Senior Services, a nonprofit that provides adult day care and other programs. He said the planning process needs “open dialogue with engaged stakeholders.”

Members of Nevadans for the Common Good pressed Anderson, chairman of the Interim Finance Committee, on whether he would ask the state Department of Health and Human Services to fold stakeholders into planning meetings.

“The short answer is yes, because the question is easy,” said Anderson, who sponsored the original bill that died in committee. “I recognize the need for these services. How they are provided must be to the benefit of those receiving care.”

Jane Gruner, administrator for the Aging and Disability Services Division, said state meetings have been more exploratory in nature. State officials have been reviewing the pros and cons of Medicaid managed care for this population and examining how similar changes have worked in other states, she said. The state intends to hold community meetings on the topic in January, ahead of a report being submitted to the governor and Interim Finance Committee.

The community meeting dates have not been finalized.

“Protecting the interests of vulnerable recipients, particularly those who cannot speak for themselves, should be top priority,” Paulsen said.

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