Why the state thinks it can save money by splitting up its health department
In today’s edition:
- The governor’s office says the budget will be balanced after amendments
- A service freeze in the Aging and Disability Services Division
- Improvement in unemployment appeals backlog
From the Capital Bureau Chief:
The federal government may not know what it’s doing, but in the legislative realm, we press forward.
The governor’s office thinks it’s on track to close a $335 million budget deficit that has dominated lawmakers’ presession budget meetings. Spokeswoman Elizabeth Ray said multiple Medicaid budget amendments were submitted on Friday, and additional amendments came ahead of the Democrat's deadline of Jan. 29 at 5 p.m.
“Once these budget amendments are submitted, the Governor’s recommended budget will be structurally balanced between ongoing revenues and ongoing expenditures and will be above the minimum 5% ending fund balance,” she said.
Meanwhile, the Nevada Democratic Party is out with a new digital video attacking the Republican governor over the budget shortfall and his “growing history of fiscal irresponsibility.”
And Gov. Joe Lombardo called concerns about the federal budget freeze “shameless political theater.”
May I remind everyone that the session hasn’t even started yet?
Time will tell us how long this shortfall issue will sting, but as always, please send us your questions, comments, observations, jokes, or what you think we should pay attention to. You can reach me at [email protected].
How does reorganizing state health agencies save money?
In his State of the State address, Lombardo proposed splitting up the state’s Department of Health and Human Services (DHHS). Medicaid, the state’s health insurance exchange, the Public Employee Benefits Program, mental health funding and other services would be spun off into the Nevada Health Authority.
During a Monday budget meeting, Nevada Medicaid Administrator Stacie Weeks gave some more details on how this will work:
- Combining all the programs under the Nevada Health Authority umbrella means that 1 in 3 Nevadans will be on an insurance plan overseen by the agency. The intent is to avoid significant operational changes but to remove siloes that exist because of how programs are divided up among different agencies in state government.
- So why is the state doing this? Weeks said it would break down existing health care purchasing silos and give the state more leverage when negotiating with insurers.
- “There’s potential that it could grow to one in two [Nevadans] that gives us a collective bargaining power with carriers that we do not have today to get a better deal, to control our costs and hopefully get better options for even our state employees,” she said.
- Context: The state is the largest health care purchaser and payer in Nevada. Officials say the new agency would allow the state to better leverage its contracting power with health plans as a coordinated agency overseeing programs such as the insurance exchange, the public option, public employee plan and Medicaid, whose carriers operate across the market.
- Coordinating health care purchasing power at the state level is not a new concept. It’s an approach that has been implemented in Washington, Oregon and New Mexico, where health authorities are looking at new purchasing strategies and contracting with health plans.
- In response to concerns raised by Democrats that the reorganization could place the state out of compliance with administering federal funds by using federally funded employees to do state work, Weeks said the state does not anticipate any problems. “I think we will continue to do cost allocation plans to the divisions as separate entities like they are today.”
— Tabitha Mueller
What we’re reading and writing
Resort industry looks to stop Nevada lottery proposal from reaching the ballot by Howard Stutz
More than two dozen legislative attempts to implement a Nevada lottery since 1887 have failed and never made it out of Carson City. Will this one?
Nevada taking long-delayed leaps toward serving people who speak limited English by Isabella Aldrete
After $25M infusion to implement plans for working with residents in other languages, agencies must now deal with the impending deadline to spend the cash.
Service freeze in the state’s Aging and Disability Services Division
Nevada’s Aging and Disability Services Division Administrator Dena Schmidt told lawmakers during a Monday budget committee the division had a budget shortfall and had to place new applicants for certain services on wait lists. Her comments followed testimony from people with disabilities who said they have been unable to receive services the state is supposed to provide.
Records from the division show that while there is no wait list for case management services, there is a wait list for contracted services. Those contracted services include supportive living arrangements for people who need help living independently, job training and a program that allows families to use a little more than $670 a month for certain types of specialized treatment, skill building and organized programming for their children.
Here’s what’s going on:
- Schmidt blamed the freezes and need for wait lists on the state’s inability to cover rate increases the Legislature passed in 2023.
- To address the demand, Schmidt said the governors’ budget has proposed a $41 million increase for requested services. While state officials said there is no wait list for case management, there is a wait list for contracted services.
- Asked by lawmakers about constituent fears of being requested to move out of single-living residences with services into group homes, Deputy Administrator Jessica Adams said a very small number of people live in one-bedroom apartments with 24-hour services, which is almost three to four times the cost of group living situations. She said the proposed budget would not cut any of those services, but officials determine the best living situation for clients on an individual basis.
- Weeks, Nevada’s Medicaid Director, discussed the need for better oversight of services for people with developmental disabilities and the state’s disability coverage system.
- Why? Medicaid funds most of the services for people with disabilities, Weeks said, noting that moves were made to create an office of compliance focused on ensuring oversight, increasing providers and reducing fraud, waste and abuse.
- She said that’s one reason the developmental disabilities council as well as the Bureau of Health Care Quality and Compliance will be moved to the proposed Nevada Health Authority — so they will be more coordinated with the Medicaid provider enrollment office.
— Tabitha Mueller
Keeping Tabs
👀 Assembly Republican Caucus hiring for new chief of staff — Multiple sources confirmed to The Nevada Independent that the Assembly Republican Caucus Chief of Staff Kevin Magee is no longer working with the caucus. The caucus is hiring a new chief of staff.
🏥 Updates on girls with autism care — At Wednesday’s Interim Finance Committee, state officials said they are spending $3.8 million to partner with Clark County, St. Jude’s Ranch for Children and Silver State Pediatrics to provide in-patient care to girls with autism spectrum disorder. Legislators said they appreciated these short-term partnerships, but that they wished there was a more long-term solution in place, which officials said would be presented within six to eight weeks.
- Context: The Campus for Hope, a project to bring a major transitional housing site to Southern Nevadans experiencing homelessness, is planning to occupy space currently used by programs that provide care to autistic girls. At a contentious legislative meeting last month, lawmakers denied a request to rescind $3.8 million originally designated to renovate that space, saying that officials needed to instead use that money to ensure that the youth would continue to receive care because of the arrival of the campus for people experiencing homelessness.
✅ Significant improvement in unemployment appeal backlog — Officials from the Department of Employment, Training and Rehabilitation told legislators Wednesday that the agency was now meeting federal standards of processing 80 percent of unemployment insurance appeals within 30 to 90 days. Kristine Nelson, the administrator of the Employment Security Division, said that one year ago, there was a backlog of about 14,000 appeals, which has since been erased.
- Context: At the start of the pandemic, the state saw a 20-fold increase in unemployment claims that bogged down the system. The agency has taken steps to speed up the appeals process, including by using artificial intelligence to automatically review an unemployment appeal, which will be checked by a state employee.
💸 Lack of communication — Confusion surrounding President Donald Trump’s order Monday to freeze federal grants was amplified by a lack of communication from the federal government. Nevada Department of Health and Human Services Director Richard Whitley said Tuesday that his staff was preparing for the freeze like they have in the past for government shutdowns. But their ability to prepare was complicated by the fact that communication with the federal government has been “systematically shut down” — with little information digitally available and program officers not responding to their inquiries. Whitley is worried in particular about long-term disability funding for children, the Children’s Health Insurance Plan and the Women, Infants and Children Program.
🧑⚖️ Lombardo deficit could impact judiciary — Nevada’s judicial branch has been having “informal discussions” with the governor’s office about potential adjustments to their budget after a $335 million deficit was found in Lombardo’s proposed budget, according to Todd Myler, the Nevada Supreme Court’s chief financial officer. Nevada’s Judicial Branch is an independent agency, meaning that they are responsible for putting together its own budget, but the deficit could still affect requested “one-shot” appropriations, such as nearly half a million dollars for replacing equipment.
— Eric Neugeboren, Gabby Birenbaum, Isabella Aldrete and Tabitha Mueller
Looking Ahead
- Thursday, Jan. 30, at 7 p.m.: Nevada Democracy Project’s live discussion about Nevadans’ biggest priorities heading into the 83rd legislative session.
- Tuesday, Feb. 11, at 6 p.m.: IndyTalks with Gov. Joe Lombardo at the National Automobile Museum Event Center in Reno.
Days until:
- First day of session: 4
- Last day for bill introductions: 53
- First house passage deadline: 82
- Sine die: 123
And to get you going into the weekend, a few social media posts that caught our eyes:
- The freezing weather in Carson City provides at least one benefit.
- The Boss had a rough weekend.
- This was funny.
We’ll see you next week.