Report pans state Medicaid performance

Nevada Medicaid fails to deliver quality care to enrollees and excludes certain people who need it because of strict eligibility requirements, according to a report released Wednesday that ranked states based on how well their programs performed in four categories.

Public Citizen ranked Nevada’s Medicaid program 40th in the nation for the quality of care provided to enrollees, kinds of services available, eligibility requirements and what it reimburses health care providers for medical services.

The state can boast about its reimbursement rates to physicians, hospitals and other medical care providers though. According to the report, Unsettling Scores, Nevada Medicaid reimburses health care providers well above the national average, ranking it third in the nation.

Draining Nevada’s score was a 49th ranking in quality of care and 46th ranking for its eligibility requirements.

As a whole, no one state can be happy with its scores, said Dr. Sidney Wolfe, director of the Health Research Group at Public Citizen and co-author of the report, during a teleconference Wednesday morning.

The report is available at www.citizen.org/medicaid.

“Medicaid is so underinsuring people, many of them would probably be added to the toll of the completely uninsured,” he said. “As it enters its fifth decade, the Medicaid program is going through a mid-life crisis. … Our scoring will give states a better idea of how they compare with others and in what areas they need to improve.”

Wolfe said the report reflects a need for either a national health care plan or for standardization of Medicaid.

Charles Duarte, administrator of the Nevada Division of Health Care, Financing and Policy, said he wasn’t surprised with Nevada’s ranking. But he questioned the way each of the categories were scored.

“As for the overall score, I think it accurately reflects where Nevada stands but I am concerned about how they may have ranked Nevada, particularly in the quality of care category. The criteria they used deals with areas which aren’t necessarily related to Medicaid,” he said. “On page 134 of the report, you can see that some of those criteria really have to do with areas like licensing, reporting problems in nursing facilities and children’s mental health. These are all very broad issues.”

Medicaid is the state-run federal insurance plan for low-income individuals. About 57 percent of funding for Medicaid comes from the federal government; the rest comes from states.

Duarte said he was also concerned about why state Medicaid programs were penalized for not offering certain services or programs when they’re not required federally. For example, Nevada Medicaid lost points in the eligibility category because it doesn’t offer a medically needy program. Medically needy programs allow states to extend Medicaid eligibility to people who may earn too much income to qualify under mandatory requirements.

To qualify for Medicaid in Nevada, children and adults must be U.S. citizens and their income cannot exceed 133 percent of the federal poverty level.

The report noted that Nevada faces particular challenges in delivering health care services to vulnerable populations because of its rapidly growing population and its transiency.

“I would like to see all of the other criteria they used in determining these scores because we (Nevada Medicaid) cover all of the preventative services,” Duarte said. “Obviously there are areas where we can do better, especially in outreach, but there are areas in which we do need more money.”

In its scoring, Public Citizen, a national consumer watchdog group, used Medicaid data from 2004 and 2005 as well as independent data gathered by the organization. It’s the only study that has evaluated the overall performance of state Medicaid programs.