Nevada Assemblyman Joe Hardy, R-Boulder City, talks with Assemblywoman Bonnie Parnell, D-Carson City, during a hearing Wednesday afternoon, Feb. 18, 2009 at the Legislature in Carson City, Nev. Earlier Wednesday, Hardy, a family physician, questioned some of the proposed cuts to the state's Medicaid system. (AP Photo/Nevada Appeal, Cathleen Allison)
Doctors and patients spoke out Wednesday against Nevada Medicaid cuts proposed by Gov. Jim Gibbons, urging lawmakers to reinstate funding with money from the federal stimulus plan.
Several doctors spoke out against the cuts at a Senate-Assembly budget subcommittee, and said that without adequate reimbursement they could no longer afford to serve Medicaid patients.
The state's Medicaid caseload has grown dramatically, and is projected to grow by over 8 percent in each of the next two years.
In the governor's proposed budget, funding for Medicaid would increase overall because the state is required to provide Medicaid funding for everyone who needs it. But hospital reimbursement rates for Medicaid services would fall by 10 percent.
Also, physician enhancements would be eliminated for pediatric and obstetric procedures, reducing doctors' reimbursement rates. Personal care service providers would see their hourly wages fall by $3 an hour.
Robyn Kaiser, an occupational therapist who serves foster children, said she is considering leaving her private practice to find work elsewhere.
"Just sitting here, in an hour, I received four new phone calls referring patients for service," Kaiser said. "If I leave my practice, where are they going to go?"
Dr. Mike Ciccolo, the sole provider of pediatric heart surgery in Nevada, said he already has eliminated staff in his office, and it will only get worse.
"The loss of the enhancements is like striking an iceberg at sea," Ciccolo said.
Charles Duarte, administrator for the Division of Health Care Financing and Policy, said that 85 percent of doctors are still accepting new Medicaid patients.
But Larry Matheis, president of the Nevada State Medical Association, challenged that figure, saying that fewer doctors are accepting Medicaid patients since cuts went into affect late last year.
"If specialists can't keep their doors open, then your pediatrician doesn't have anyone to refer to," said Assemblyman Joe Hardy, R-Boulder City, who is a family doctor.
Personal care providers, who assist disabled and elderly in their homes, would see their income fall from about $18 per hour to about $15 per hour. Duarte said that other states pay their personal care providers at a lower rate than Nevada.
"I'm always concerned that we compare ourselves with states that have lower cost of living than we do, because people just need to have this service," said Sen. Bernice Mathews, D-Reno. "It's not like they can go out and pound the pavement."
"If they can't afford to work for a lower pay rate, then I don't get out of bed that day," said wheelchair-bound Tiffany Hunter, who receives care in her home in Stagecoach.
Two agencies that provide pediatric home health care, Colonial Maxim in Las Vegas and Maxim in Reno, already have stopped taking pediatric Medicaid patients, Duarte said.
"The entire committee understands how important all these items are, because we're the ones that voted on them last session," said Assembly Speaker Barbara Buckley, D-Las Vegas.
"The stimulus money is going to help us with Medicaid and with the health care budget, but it will not provide full funding."