Willden noted that Medicaid patients in long-term care facilities are required to use all but $100 of their meager incomes, often Social Security checks, to help pay nursing home costs that run thousands of dollars per month. The state then pays the difference.
"That's a form of cost sharing," he said.
He cited other examples, such as Nevada Checkup, an insurance program for children in households with incomes that slightly exceed Medicaid eligibility. Those families pay a quarterly premium between $25 and $80, depending on their income.
Another, the Katie Beckett program, authorizes Medicaid coverage to severely disabled children younger than 18 so they can be cared for at home. "We allow parents with pretty high incomes, up to $100,000 sometimes, to share in the costs," Willden said.
But Sasser said those examples are not an accurate comparison to the overall Medicaid population.
In nursing homes, he said, patients are receiving "all the basic necessities of life," while Nevada Checkup families have higher incomes than Medicaid recipients. Under the federal health care law, Nevada has agreed to expand its eligibility to people with incomes up to 138 percent of the federal poverty level. For a family of four, that equates to $31,809.
Nevada Checkup insures children through 18 years old who don't qualify for Medicaid; are otherwise uninsured; and whose family's gross annual income is up to 200 percent of federal poverty — $46,100 for a family of four.
Willden said U.S. Health and Human Services Secretary Kathleen Sebelius issued new copay regulations in the past week. The state is reviewing those before recommending how cost sharing should be applied in Nevada.
Whatever the outcome, Willden said it won't keep Medicaid patients from receiving necessary care.
"We can never deny a Medicaid recipient access to medical care," he said.
The topic will be debated in the upcoming Nevada Legislature that begins Feb. 4.