Legislator questions need for Medicaid co-pays, premiums

CARSON CITY — Senate Finance Committee Chairwoman Debbie Smith on Wednesday questioned the value of implementing cost sharing in Medicaid given the enormous task facing the state of expanding the program under the federal health care law.

“I keep thinking that all the heavy lifting that needs to be done to get this implemented, and all the discussions already we’ve had today, it just seems like one more huge lift,” said Smith, D-Sparks. “We might raise $2 million, spend $1.7 million just to implement this. And with everything else on your plate, is that worth it?”

Gov. Brian Sandoval has proposed requiring some Medicaid recipients to pay for a share of the program, saying in his State of the State address that “we must ask certain Medicaid patients to make a modest contribution toward the cost of their own care.”

He has proposed expanding the program to cover more Nevadans under the federal Patient Protection and Affordable Care Act. If the expansion is implemented by the Legislature, Nevada’s Medicaid population is projected to grow from 319,827 Medicaid recipients at the end of the current budget on June 30 to 490,103 on June 30, 2015, a 53 percent increase over two years.

Medicaid is a federal and state shared program that provides health care coverage to low-income residents, including children, the disabled and the elderly.

The Medicaid budget was reviewed by the Senate Finance and Assembly Ways and Means committees Wednesday.

Whether the cost sharing concept would come in the form of premiums or co-pays is still under review and would have to be approved by lawmakers before one of them could go into effect.

Mike Willden, director of the Department of Health and Human Services, said rules on how states can require Medicaid recipients to participate in cost sharing were issued by the federal Department of Health and Human Services on Jan. 14 and are still being evaluated.

The agency requires cost sharing in the Nevada Check Up program, which charges premiums, he said. The program provides medical coverage to low-income, uninsured children who are not covered by Medicaid.

Any co-pays implemented in Medicaid for doctor visits or prescriptions probably would be small, possibly in the range of $3 to $5.

But Smith said many Medicaid recipients have very low incomes, and even this amount could pose a hardship.

There needs to be a focus in the Medicaid program on educating participants on how to access the right level of care, seeing a primary physician, for example, rather than going to a more expensive hospital emergency room, she said.

Assemblywoman Lucy Flores, D-Las Vegas, echoed Smith’s concerns about the ability of Medicaid participants to pay but said she is not opposed to requiring cost sharing if recipients can afford it.

With the Medicaid expansion, now might be a good time to take up a broader review of cost sharing in the state’s programs, she said.

Jon Sasser, representing Washoe Legal Services and the Legal Aid Center of Southern Nevada, said he is awaiting a cost sharing proposal before commenting in detail. But he, too, echoed Smith’s concerns about whether recipients could afford co-pays and questioned whether the administrative costs of such a plan might be more than would be gained.

Contact Capital Bureau reporter Sean Whaley at swhaley@reviewjournal.com or 775-687-3900.