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Medicaid cost sharing will be hot debate in Nevada

Published on NewsOK Modified: January 19, 2013 at 1:24 pm •  Published: January 19, 2013

CARSON CITY, Nev. (AP) — Gov. Brian Sandoval's recommendation that Medicaid recipients share in the cost of care has been met with criticism from advocates for the poor, but the agency chief who oversees Nevada's complex social safety net programs says such requirements are not a new concept.

"We already do cost sharing," said Mike Willden, director of the Department of Health and Human Services. "Every state does some sharing."

But critics say while that may be true for some programs, requiring copayments from Nevada's poorest residents to receive care goes beyond acceptable boundaries.

"This is a tax. It's a tax on poor people," said Bob Fulkerson, executive director of Progressive Leadership Alliance of Nevada.

Sandoval, a Republican, first mentioned cost sharing when he announced in December his decision to expand Medicaid eligibility as called for under the federal Affordable Care Act. Sandoval reiterated his stance in his State of the State address Wednesday night, saying, "I believe we must ask certain Medicaid patients to make a modest contribution toward the cost of their own care."

What constitutes a "modest" contribution has not been determined, though Sandoval has suggested it could be $1, maybe $5, to see a doctor.

But Willden, speaking with The Associated Press, said cost sharing could take other forms, such as requiring some sort of payment for when a recipient seeks care at an emergency room for something that could have been treated by a primary care doctor.

"We don't know exactly what our final rules will be," Willden said. "We have not locked into how we're going to do that."

Willden said the goal is not to pad state coffers, though the governor's budget estimates cost sharing would save the state general fund about $700,000 in the 2015 fiscal year.

"It's not really being built as a tool to save money," Willden said, adding the concept is more about "personal responsibility."

"It's all about those kinds of principles, about how we get more personal responsibility and better health care outcomes," Willden said.

Fulkerson on Friday called that reasoning "insulting" to poor people.

"Absolutely, it's insulting because it insinuates they have no personal responsibility" and are to blame for being in poverty, he said.

There's no evidence, said Jon Sasser, advocacy coordinator for Washoe Legal Services, "that low income people overuse medical services and need to pay a copayment to keep them from going to the doctor willy-nilly."

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