Health and Human Resources Director Mike Willden told lawmakers on Tuesday that proposed cuts in his department will mean serious reductions in services for Nevada's poor, children, seniors and the disabled.
The list totals more than $109 million in cuts in general fund money, which results in the loss of an additional $83.5 million in federal funds.
In addition, he warned the Interim Finance Committee the state will have shortfalls in entitlement programs. Medicaid is expected to have 40,000 more clients than it budgeted for by the end of the two-year budget cycle. Welfare will have 4,200 more people to serve than budgeted, and food stamps for as many as 109,000 people.
The Medicaid shortfall alone is projected at more than $60 million.
As for the program cuts, Willden said a significant number of people will lose services they rely on daily, including personal care attendants, adult day care services, vision care, traumatic brain injury rehabilitation and speech and occupational therapy.
"We're down to a very ugly list of options," he told lawmakers on IFC.
"These are things we just find utterly abhorrent to be discussing," said Assembly Speaker Barbara Buckley, D-Las Vegas.
She pointed out that many of the options are the same choices lawmakers rejected in the 2009 Legislature.
"This is why we raised revenue last session," she said.
Senate Minority Leader Bill Raggio, R-Reno, strongly objected to some of the cuts.
"Reducing the number of diapers that seniors who are incontinent are going to be able to get, it's heartbreaking," he said.
Among the cuts proposed by the governor:
• Gaining $40.89 million by sweeping tobacco settlement money from the Fund for a Healthy Nevada and the Public Health Trust Fund.
• $1 million by increasing premiums for Nevada Check Up, which provides health coverage to the children of Nevada's working poor. Premiums would triple to $300 a year at the lowest level.
• $2.5 million by eliminating adult denture coverage in Medicaid.
• $2.1 million by eliminating adult day care.
• $829,000 by cutting incontinence products - adult diapers and bed pads - nearly in half for seniors and another $824,000 by eliminating purchases of disposable gloves for personal care service attendants.
• $5.3 million by reducing Medicaid hospital reimbursement rates and $2.5 million by reducing Medicaid reimbursements to anesthesiologists to Medicare levels - a 43 percent reduction.
• $1.8 million by eliminating the problem gambling program and taking the fee on annual slot machine licenses that funds it.
• Cutting reimbursement for personal care attendants by $1.50 an hour, saving more than $7.4 million.
• $7.6 million by eliminating funding for supported housing arrangements for those with developmental disabilities.
• $1.4 million by eliminating 77 staff in the welfare division, slowing capacity to process applications.
• $1.6 million savings by closing the Summit View Correctional Center for juvenile offenders, transferring them to other facilities.
• Pharmacy savings totaling $8.2 million due to steering Medicaid and Medicare clients to private pharmacies and increased use of generic medications.