LAS VEGAS (KLAS) — When House Republicans on Monday unveiled a plan for at least $880 billion in cuts, mostly to Medicaid, the implications for Nevadans began to come into focus.
Foremost is a mandated 80-hour-per month work requirement that would be attached to benefits for able-bodied adults ages 19-64. Medicaid has ballooned as employees with no medical benefits have come to rely on the program for their health care needs.
Volunteer work and school would count toward the work requirement.
Patrick Kelly, president and chief executive officer of the Nevada Hospital Association, emphasized that it’s still very early in the process. He said he expects the Republicans’ proposal to change as it moves forward.
The biggest questions have to do with changes in who is eligible for Medicaid benefits, Kelly said.
8 News Now has reached out to the Nevada Department of Health and Human Services for additional comment on the proposal.
Statistics from August indicate two out of three Nevadans who receive Medicaid are working. The bulk of Medicaid expenditures — about two-thirds of the total — goes for care to adults and children, with the other third going to the elderly and individuals with disabilities.
While there are no state-by-state estimates yet, the Congressional Budget Office said the proposals will reduce the number of people with health care by 8.6 million over the decade.
The goal of the cuts is to come up with at least $1.5 trillion in savings to continue tax breaks that were put in place during President Donald Trump’s first term. Those tax cuts were due to expire at the end of the year.
Among the other factors that could affect Medicaid:
- Medicaid beneficiaries with incomes over the federal poverty line ($15,650) must pay up to $35 per medical service. That cost is likely to be based on family income, Kelly said.
- Requirement to do eligibility checks on expanded Medicaid enrollees every six months. (Previously, checks were done once a year.)
- State Medicaid programs can’t reimburse health care providers, such as hospitals, more than Medicare does. Kelly said that might not apply if the state was already reimbursing at a higher rate. Those programs might be grandfathered in.
- States are banned from adding or increasing provider taxes to help finance their portion of Medicaid costs. (A freeze that would not reduce benefits by itself.)
- Ban on Medicaid and Children’s Health Insurance Program (CHIP) funding for gender affirming care.
- Restrictions on large abortion providers from getting Medicaid funding.
- Bars “middlemen” pharmacy benefit managers from charging higher prices to Medicaid than they actually pay for drugs.
According to Kelly, the result of these changes will be higher insurance rates in the coming years. He said if someone isn’t eligible for Medicaid, they still get sick and they still go to the hospital.
The cost of that “uncompensated care” is shifted to the cost of commercial insurance, but it takes years.
Information published in August shows 811,962 people were enrolled in NV Medicaid.
An estimated 368,000 people are eligible for benefits under expanded Medicaid.
Stacie Weeks, administrator over Nevada Medicaid, said during a February hearing at the Nevada Legislature that 66% of Medicaid recipients are underemployed.
She said if reimbursements are not paid, it will place an enormous burden on hospitals and doctors, Weeks said. It would have the deepest impact on people who are getting the 90-10 coverage under expanded Medicare.
“If you can’t fill that hole or we don’t find ways to make cuts to address it, it would impact coverage and our ability to pay medical services for that 300,000 people,” Weeks said.
The federal government took aim at California with a rule aimed at the state’s practice of routinely treating illegal immigrants. Doing so would bring a penalty under federal rules, dropping Medicaid reimbursement rates to 80%. They are currently 90%.
