Social services may be too costly for rural Nevada counties

CARSON CITY — Poorer rural Nevada counties might not have the money to pay the costs of state-performed social services that the Legislature dropped on them.

Jeff Fontaine, executive director of the Nevada Association of Counties, said he is concerned especially that Mineral and other rural counties don’t have the money to cover the Medicaid matching funds the state demands they pay for care of nursing home patients.

While most nursing home costs are covered by the state and the federal government through Medicaid grants, the Legislature and Gov. Brian Sandoval want county governments to pay
$14.5 million to cover a share of costs incurred by 3,100 people. These are people whose incomes are just above poverty levels. About $9.5 million of the costs will be billed to Clark County.

Fontaine said the Mineral County residents can’t increase their property taxes — they already pay the maximum — and the county does not have any spare funds.

Nevada Department of Health and Human Services Director Mike Willden said that he is aware of financial problems of the rural areas and that he might have no choice but to grant them exemptions.

“I have pretty broad authority,” said Willden, noting legislators did not approve legislation to allow counties to increase their maximum property tax rates.

Despite the long recession, Willden predicted there will be no decline in social services provided Nevada residents if the counties pay their assessments.

He said that in the final weeks of the legislative session, the administration kept elder protection programs and other programs that had been earmarked for shifting to counties.

The state’s costs for child protective services incurred in rural Nevada now must be paid by those counties. But Clark and Washoe counties already run their own child protective service programs.

State government will continue to pay $3 million to continue to operate county mental health court programs.

Clark County is not one expecting any problem in paying for services that the state provides.

Going into the legislative session, the Clark County government expected the state would push $88 million in service costs onto them.

They ended up with about a $30 million additional cost over the next two years.

The county will have to pay $20 million for state-operated social services programs. The state also eliminated
$5 million in state-run social service programs that Clark County now will operate itself.

Besides social services, other parts of county government were hit with additional costs.

The county must pay $5 million to have the state conduct pre-sentence investigations of suspects for the court system and $556,000 to cover some costs of the fire and emergency medical technician services at the Nevada Division of Forestry fire station at Mount Charleston.

But there were positives for Nevada’s two most populous counties.

Sandoval’s plan in January was to grab property tax revenue in Clark and Washoe counties to cover part of the costs of higher education.

That didn’t happen. In a May 26 decision, the Nevada Supreme Court decided state government could not raid local and school district funds.

The return of that money means Clark County can use it to cover its own needs. Instead of a $50 million funding shortfall next year, its shortfall will be $42 million.

“It a lot less of a problem than it could have been,” said Sabra Smith-Newby, a legislative lobbyist for the county.

But even with the court decision, the Legislature and Sandoval still took $38 million in local property taxes that would have gone to county hospitals to cover the medical costs of indigents injured in traffic accidents. Of that total, as much as $24 million would have gone to University Medical Center.

Fontaine could only speculate why state administrators and legislators thought they could take that money. The Supreme Court decision specified that legislation taking money from one or two counties and using it to fund statewide budget needs was unconstitutional. The indigent accident tax is imposed in all 17 counties, so taking money from all counties is not being considered unconstitutional, Fontaine surmises.

“You can have a hospital bill of $100,000, and that is a charge to the county,” Fontaine said. “Think of what could happen to a place like Pershing County if there were a bus accident on Interstate 80? Having the indigent funds is very important.”

Besides requiring counties to pay some nursing home care costs, the state also ordered them to pay a combined $11.5 million to provide mental health services for intellectually challenged children. About $6.4 million must be paid by Clark County to have the state continue to operate such services.

Willden said counties can “opt out” of the program, but they would be required first to develop any alternative program of their own.

Counties also must pick up the tab for $5.4 million for the state to operate youth parole programs. About $3.9 million is expected from Clark County, although counties can elect to provide the services themselves.

Eliminated by legislators was the
$1.2 million program under which the state pays for TB and sexually transmitted disease tests in the counties. About $816,000 went to Clark County.

Carson City, Clark and Washoe counties have health districts that must continue to provide this service. But the other 14 counties will pay the state fees for the tests, unless they decide to perform them on their own.

Contact Capital Bureau Chief Ed Vogel at evogel@reviewjournal.com or 775-687-3901.