TONOPAH — Misused grant funds, sloppy record-keeping and undertrained staff at state-run rural reproductive health clinics led Nevada to lose hundreds of thousands of federal dollars over the past two years.
As a result, services and staff hours have been slashed and low-income women seeking contraceptives and pregnancy consultation have been turned away.
The clinics described as being in a state of disarray in a scathing 2015 federal audit have since seen only deeper cuts — until this week.
After public health professionals in rural Nevada pleaded for help, Republican Gov. Brian Sandoval agreed on Thursday to replace lost funding.
Health advocates say state aid for the vast northern half of Nevada could remedy what they described as a potential contraception desert for women without health insurance.
With Sandoval’s approval, Nevada is setting aside $1 million over the next two years for family planning services. Nonprofits like Planned Parenthood and metropolitan health centers can apply, but the money is geared toward small-town providers under the state’s jurisdiction.
“They’re on life support,” community health advocate Shaun Griffin said. “I don’t think people were aware of the acuity of the situation.”
Each of Nevada’s 13 Community Health Nursing clinics offers the only location within a minimum 100-mile radius for anyone without coverage or afraid to ask their parents to get affordable birth control, health screenings and pregnancy consultation. In some places, insured residents also rely on the clinics.
“The reality is that there are no private providers for this care in some of the rural areas, Tonopah being an example,” the program’s only Advanced Practice Registered Nurse and head of the Tonopah clinic, Beth Ennis, wrote to the governor’s office.
The U.S. Department of Health and Human Services denied the state’s application for nearly $600,000 from Title X grant program that funds family planning in April 2016, citing the same administrative, financial and clinical disorganization the agency detailed in the audit eight months earlier. Nevada was later able to secure a fraction of the aid.
Both the federal and state funds legally cannot be used for abortion services or medications.
The audit report specified 22 points on which the Nevada Division of Public and Behavioral Health was failing to properly make use of the grant.
It repeatedly criticized a lack of protocols and said the clinics did not conduct services within nationally recognized standards of medical care.
Among other things, it said the state shortchanged certain activities and geographic areas the grant was supposed to cover, staff loosely tracked clinic activities and costs in violation of federal regulations, and administrators failed to monitor services and financial compliance.
For instance, billing formulas may have been “legally inappropriate,” the report said, and staff was unaware of any expectations to check prescription drug inventories.
“They did goof up, badly, unquestionably, the revenue just evaporated,” Griffin said.
Tina Gerber-Winn, the division’s clinical program manager, argues the funding decline has not affected rural clinics because the loss coincided with diminished demand. Some 300,000 Nevadans have gained health insurance since Sandoval opted to expand Medicaid in 2012.
After the state’s 2016 application was denied, Gerber-Winn said her office was able to obtain an annual $200,000 Title X grant by showing that the state had begun to address some of the program’s organizational issues and by downsizing the population the rural clinics will serve from 3,800 to 1,400 people.
Gerber-Winn said her office directed clinic staff to turn away patients with insurance, even if they preferred to see a public health nurse.
At the same time, six of the state’s roughly one-dozen rural public health nurses were cut to half-time and medical supplies including birth control were reduced, Griffin said, putting staff in a panic.
The nurses declined to comment. Several said they were either uncomfortable speaking to the press or fearful of retaliation.
“Change is difficult,” Gerber-Winn said. She added, “I think they’re worried about the money part of it realistically, but we’ve managed to cover the needs with our budget.”
Division of Public and Behavioral Health Administrator Cody Phinney told lawmakers this session, and repeated in phone interviews, that the state qualified for less funding due to changes in the grant program that give a leg-up to urban clinics.
Phinney and division staff did not tell lawmakers about the audit during multiple budget hearings this year — the first regular legislative session since the critical report.
State officials have taken some corrective actions since the audit, including updating computer systems to track medical information and finances, and expanding written instructions for staff.
Gerber-Winn said the state plans to apply for the same level of funding when Title X applications open in two years.
A truer test could come as early as fall, when Gerber-Winn said the U.S. Department of Health will conduct another audit.