Workers will plead for clients who could lose medical care

Clark County Social Service is facing another budget dilemma.

The agency that serves the poor who fall between the cracks of other programs must cut its medical assistance program by $13 million because property taxes, which pay the bills, are sagging.

Nancy McLane, director of the social service agency, sees only one option: Raise the eligibility standards, making it tougher to get medical help.

On Tuesday, she will ask Clark County commissioners to approve her solution even though it will kick about 2,100 people off medical assistance if commissioners approve.

Under the current standard, a single person with a monthly income of no more than $1,435 is eligible. With the proposed change, a single person can earn no more than $1,065 a month to qualify. For a couple, the standard will go down from $1,925 to $1,433 a month. These aren’t people who qualify for Medicaid; these are people without coverage. Over a year, about 30,000 turn to the county for medical assistance.

In the past four fiscal years, the medical assistance budget has dropped from $89 million to $44 million. That’s going far beyond eliminating fat, folks.

The director is hopeful nonprofits will be able to pick up the slack and provide for those bumped off the county program. May that optimism be warranted.

The 7,000 people currently enrolled were notified, but whether they understood the ramifications is doubtful. Only 48 clients have expressed concern, McLane said.

In July 2009, when McLane was asked to cut $9.3 million from the budget, eight workers spoke on behalf of their fragile clients to the commission. Their heart-wrenching presentations caused commissioners to vote to reject McLane’s proposals to cut successful programs including Homemaker Home Health Aide Services, which provides home care that keeps people out of nursing homes.

County managers were told to find the $9.3 million.

McLane was able to find $2.3 million to save Homemaker Services, but legal restrictions prevented the county from just shifting dollars around, so she had to cut $7 million. Part of the solution involved reducing staffing by 25 percent in the past two years.

Commissioner Chris Giunchigliani plans to object to the eligibility reductions, particularly for Homemaker Services, which is part of the medical assistance program.

“We have enough money someplace where we don’t have to change that,” she said.

Hope she knows where that money is hiding.

At Tuesday’s commission meeting, McLane will ask that instead of using the standard of 180 percent of the 2005 poverty level for the maximum eligibility, the standard drop to 118 percent of the 2009 federal poverty guidelines. This is the most significant of many changes she will be presenting and deserves having a spotlight shined upon it.

The chronically ill and frail elderly who receive this help are unlikely to be able to attend, even presuming they understand the ramifications of the eligibility changes.

Once again, some workers plan to speak for their clients, such as Trace Wolf, who provides home care. She has 300 clients. Under this proposal, that would drop to 150. She helps them with bathing and shopping .

“These are the poorest of the poor,” she said.

There will be a perception of savings by eliminating them from the county program, but Wolf predicted they will just end up having to go to nursing homes or assisted care instead of staying home and living as independently as possible.

We’ll see whether the workers’ statements Tuesday make any lasting difference. But this won’t be the last time we’ll be hearing about the brutal reality of budget cuts.

Jane Ann Morrison’s column appears Monday, Thursday and Saturday. E-mail her at Jane@reviewjournal.com or call (702) 383-0275. She also blogs at lvrj.com/blogs/morrison.