Optional, not Covered in Nevada

Podiatry services Optometry services Chiropractic services Other practitioner services

State plan home and community-based services

Self-directed personal assistance services Community First Choice Option Tuberculosis-related services

Other services approved by the secretary

Health homes for enrollees with chronic conditions program occurred when Sandoval expanded the state program as authorized by the ACA, resulting in dramatic increases in the number of recipients and the cost over the next several years.

Growth of Nevada’s program also has been fueled by a migration of many low-income seniors to the state, said Meredith Levine, director of economic policy at Nevada’s Guinn Center for Policy Priorities, a nonprofit, bipartisan policy analysis and research center.

“We have the fastest growing low-income senior population in the country,” she said, noting that many of the newcomers qualify for both Medicare and Medicaid.

State’s spending marches upward

The steady expansion of coverage and the covered is easy to see in the state’s budget. In 1975, Medicaid spending cost $24.4 million and comprised 6.6 percent of the state budget, according to the Legislative Appropriation Report of 1986. Federal funding provided $13.3 million and the state share was about $11.1 million, with a small amount of county and other funding also included.

Today, Nevada’s Medicaid program costs nearly $3.23 billion, or about 27.1 percent of the total budget. That translates to $2.4 billion from the federal government and about $764 million in state funding. While Nevada’s rapid population growth has undoubtedly contributed to the increasing cost of Medicaid, that only accounts for a small slice.

State records show that while the population increased from 619,000 in 1975 to nearly 3 million in 2016 – a jump of 375 percent — the number of Medicaid enrollees skyrocketed over the same period. That figure leaped from around 23,333 in 1975 to more than 608,104 in 2016 — a 2,506 percent increase.

Medicaid’s growth in Nevada has been mirrored on the federal level. It now provides health coverage in some states to low-income, childless adults, the elderly, drug addicts, people with disabilities as well as almost two-thirds of the Americans in nursing homes. All told, some 74 million Americans receive Medicaid, nearly 35 percent more than the 55 million enrolled in Medicare.

Doris Kearns Goodwin, a former member of LBJ’S White House staff and later one of his biographers and close confidants, feels sure the Texan who rose from poverty to promote a “War on Poverty” never dreamed that any state would have more residents receiving their health insurance from Medicaid rather than Medicare.

“The focus back then (in the

1960s) was more on making sure the elderly could receive medical care,” she said. “But I’m sure he’d be happy with what’s happened. He had a special concern for people who couldn’t afford decent health care and now many people are getting it with Medicaid.”

Contact Paul Harasim at pharasim@reviewjournal.com or 702 387-5273. Follow @paulharasim on Twitter.