Reno finds Medicaid expansion a tough hand to play
many of whom suffer from multiple chronic conditions.
“We are struggling to keep up with demand for care,” said Chuck Duarte, the state’s former Medicaid chief who directs Community Health Alliance, the region’s largest federally funded community health center.
He said he’s worried the problems will escalate when the second Obamacare enrollment period begins Nov. 15.
Nevada Gov. Brian Sandoval was the first Republican governor to embrace Medicaid expansion after the Supreme Court made that provision of Obamacare optional for states in 2012. In December 2012, Sandoval estimated about 78,000 Nevadans would gain Medicaid coverage starting in 2014.
In fact, Medicaid enrollment grew from 330,000 Nevadans in September 2013 to more than 601,000 in August 2014 — an 82% increase, according to state figures. That compares with average enrollment growth of about 20% in the states that expanded the program.
Among the reasons for the rapid take-up in Nevada were its high uninsured rate and previously stingy Medicaid guidelines, which excluded childless adults and covered jobless parents with dependent children only if their households made below 24% of the federal poverty level, or about $5,700 for a family of four.
The new enrollees turn out to have far greater health needs than the mothers and children who previously dominated the Medicaid rolls, said Eric Lloyd, chief executive of Amerigroup of Nevada.
Without enough exam space and providers to keep up with demand, the health center, which saw 26,000 patients last year, turns away hundreds of patients a week seeking immediate care, he said.
“We’ve been told by our Medicaid managed care organizations that we have several thousands of their members waiting for their first appointment,” Duarte said.
Even so, there are individual success stories.
Karen Silverman, 61, is one of those. Working as a parking lot attendant without health coverage, she often could not afford the drugs to treat her high blood pressure and diabetes.
“I would forgo my cholesterol or blood pressure medicine, so I could afford my insulin,” she said. “It was scary, but I had no choice.”
Since enrolling in Medicaid, she pays nothing for prescription drugs or doctor visits. After several months of taking her medications regularly, her diabetes and blood pressure are better controlled and she has started walking again.
“I feel as if my life is back on track,” she said.