Watchdogs: State Medicaid program among worst in nation

The percentage of low-income Carson City residents in need of medical care are congruous with population numbers.

For state fiscal year 2007 approximately 2.56 percent of the state's Medicaid caseload is at Carson City. Carson City represents about 2.2 percent of Nevada's population according to the state demographer.

"So, if you look at it in that respect - we're pretty close," said Tami Dufresne, coordinator of research and statistics for the division of welfare and supportive services.

About 87 percent of those receiving Medicaid reside in Clark and Washoe counties. One state administrator said Carson's 2 percent may not represent everyone who may benefit from Medicaid.

"We serve quite a few people," said Nancy Ford, an administrator with Nevada's division of welfare and supportive services. "It's not as many as who may be eligible. There are people out there who may be eligible, but don't know."

In Nevada last year, Medicaid - a federal program which provides health care to low-income families, as well as aged, blind and disabled individuals - covered 172,685 individuals.

Through June, Medicaid has provided care to 168,000 statewide, numbers slightly down from last year perhaps due to a new clause requiring recipients to prove citizenship, Ford said.

Some Carson residents in need of immediate medical attention say they're the ones being left behind.

"I've been back and forth with Medicaid this year," said Carson resident Cheryl Gorman, 47, who needs a hip replacement. "A denial came in May - I am doing a letter now. I have gone to the attorney ... I have medical records and am taking them to the governor's office.

"I need extra help because I'm tired of fighting it - I'm tired of fighting Medicaid."

Ford said cases like Gorman's can merit special consideration.

"If someone has a real emergency going on where things need to move quicker, we can work with them," she said.

The state's Medicaid program has recently been ranked amongst the worst in the nation.

In April, Public Citizen, a public-interest watchdog organization founded by consumer advocate Ralph Nader, ranked Nevada's Medicaid program 40th in the nation for quality of care provided to enrollees, services available, eligibility requirements and what it reimburses health care providers for services.

The report said Nevada's rapid growth and high transient population were factors for its low ranking.

"I've seen the denial letters," Gorman said. "I'm in the middle of it now. It's been total hell."

State law dictates "Medicaid does not provide medical assistance for all poor persons. Low income is only one test for Medicaid eligibility; for some eligibility groups, assets and resources are also tested against established thresholds."

And for those waiting for a go-ahead from Medicaid for a pending procedure, there is no easy way to speed up the process, state officials said.

"Generally people can show they're pending Medicaid, that might help," Ford said. "A lot of providers are not willing to provide services unless there's a pay source."

• Contact reporter Andrew Pridgen at apridgen@nevadaappeal.com or 881-1219.

Information

For information on Medicare and Medicaid visit:

www.cms.hhs.gov/default.asp?fromhcfadotgov=true

For information on the state of Nevada's health visit the Web site below and click the "Medicaid and Nevada Check up Factbook" link: http://dhcfp.state.nv.us