Carson City hospital defends denial of Medicaid inmates

Carson Tahoe Regional Medical Center’s decision to stop accepting Medicaid eligible inmates as patients reared its head in the legislative overview of the governor’s budget on Tuesday.

Carson Tahoe Health CEO and President Ed Epperson last fall defended the decision citing the disproportionate cost to the capital’s hospital. He said the impact was “devastating.”

The problem developed after the Affordable Care Act provided the prison system with a great financial break by making the majority of inmates eligible for Medicaid benefits.

Before ACA, Deputy Director of Corrections Scott Sisco told the combined Assembly Ways and Means and Senate Finance committee few inmates were Medicaid eligible so it was never an issue with the hospital.

He said last fall moving inmates to Medicaid was budgeted to save $5.2 million a year.

“In reality, it was shifting the cost of inmate health care to hospitals and the federal government,” Epperson said.

“Our small community cannot bear the medical cost of the state prison system, only receiving reimbursement for a mere 10 percent of charges.”

The problem for the hospital, according to Epperson, is Medicaid pays far less than the Hometown Health Plan policy that formerly provided inmate medical coverage.

“We’ve gone from cost plus a small margin to 10 percent on the dollar,” Epperson told the Northern Nevada Development Authority in August.

In a statement released Tuesday afternoon, Epperson repeated that statement.

“The prison system does not carry inpatient insurance on their inmates nor does NDOC prove its own inpatient services,” he said. “Therefore, it relies heavily on local hospitals.”

He said for its size, CTH receives a much larger percentage of inmate patients than other Nevada hospitals. Because of the ACA, Epperson said the overall percentage of inmate patients seen at Carson-Tahoe has grown to 37.2 percent of the total inpatient inmates compared to just 7 percent at Renown and 4 percent at Saint Mary’s in Reno and 19.4 percent at the University Medical Center in Las Vegas.

“We’re very disproportionately affected,” Epperson said. “The burden is just not affordable.”

Director of Corrections Greg Cox said since that cut-off, Medicaid inmates needing treatment have had to be scheduled at Reno hospitals.

Epperson and prison officials emphasized CTH still accepts emergency Medicaid inmate patients.

“No person, including prisoners, are turned away from emergency services,” Epperson said.

But he protested what he said were two “egregious” cases in which prisoners were “virtually left at Carson-Tahoe ER for no physical reason.” Epperson said in those cases, the hospital was simply informed the inmate had been released from prison as the prison officers left.

He said those cases cost CTH nearly $270,000 for which they were reimbursed just $36,000.

Sisco pointed out CTH hasn’t cut off admitting other Medicaid patients, just those who are inmates.

He said Nevada isn’t the only state to run into this problem since the Affordable Care Act took effect. He said Washington state’s response was to mandate hospitals there have a contract with the Department of Corrections in order to keep their state license.

“We have talked about this issue with Carson Tahoe refusing these patients for almost a year,” said Assemblyman James Oscarson, R-Pahrump.

Prison and CTH officials have been discussing the issue for the past year but without finding a solution.

“We’re going to start meeting about it and discussing it,” said Oscarson after the meeting.

CTH received some support from Sen. Ben Kieckhefer, R-Reno, who said the change in federal Medicaid eligibility “tripled that inmate mix,” sharply increasing the Medicaid population in the hospital.

He said he was concerned about making sure Carson City’s local hospital can survive financially.

Cox told lawmakers this problem is new to the relationship with the hospital.

“We’ve had a great relationship historically with Carson-Tahoe,” said Cox. “They’ve always been good partners with us up until now.”

Cox told lawmakers none of Nevada’s other major hospitals have cut off serving Medicaid eligible inmates: “The other hospitals we have have stood up and helped us.”

Epperson said CTH staff was working with Gov. Brian Sandoval’s office to find a solution.