Faced with increasing demand caused by the faltering economy, Gov. Jim Gibbons was forced to add $202 million to the Medicaid budget for the coming biennium.
More than 191,000 Nevadans receive Medicaid benefits.
That budget " along with several budgets where the governor has proposed unpopular reductions " will be presented to the legislative money committees Monday.
Medicaid's proposed budget for the biennium totals $2.54 billion, about $1 billion of which is state General Fund money. Nearly $50 million of the total cost is attributed to medical inflation for the next two years and mandatory rate increases imposed by the federal government.
The proposed budget is betting on an increase in the share of total costs supported by the federal government from 50 percent to 58 percent, an increase of nearly $100 million.
Budget Director Andrew Clinger said Friday that if the legislation before the U.S. House of Representatives passes, the state will actually get a lot more than that.
While the Medicaid budget increases are largely outside state control, lawmakers are expected to have some tough questions about other parts of the Health Care Financing and Policy division budgets. They already have objected to the additional 5 percent reductions in hospital inpatient rates the state pays. Added to the reductions imposed this year, that brings the total cut in hospital rates to 10 percent.
Those reductions save nearly $22 million during the biennium but at least two rural hospitals have warned the cuts could force them to close.
Another proposed reduction that has already drawn fire in other budget accounts is the $3-an-hour cut in what personal care attendants receive, saving more than $10 million but raising concerns some of those people might change professions, potentially causing some people now living at home to be institutionalized. The cut will knock them down to $15.50 an hour.
There also may be questions about continuing the reductions to pediatric and obstetrics payments imposed this year, which save more than $8 million.
Another $1.8 million in savings would come from shifting Medicare Part D county match payments to the counties, which has drawn objections from local governments.
Health programs, however, aren't the only issues before lawmakers Monday. The Department of Corrections also will present its case.
The biggest issue there has been legislative objections to spending more than $220 million to build a new state prison while simultaneously shutting down Nevada State Prison in Carson City and leasing the Jean Prison in southern Nevada to the federal immigration authorities. Corrections Director Howard Skolnik has said NSP requires a staff ratio of 17 inmates to 1 staff member while the new designs can be staffed at less than 30:1. Closing NSP, he said, will save $18 million.
The prisons budget totals $576 million. While that is a reduction, it's smaller than most agencies are facing because of concerns about public safety and the potential for lawsuits that could result in federal courts taking control of the system.
Also on Monday's agenda are the judicial branch and the Department of Public Safety. The meeting starts at 8:30 a.m.
- Contact reporter Geoff Dornan at gdornan@nevadaappeal.com or 687-8750.