Though hospitals and medical providers were hopeful that cuts made to the state’s Medicaid program last month would be restored after federal matching dollars were extended through the end of the year, the head of Nevada Medicaid told lawmakers Thursday it might be some time before that can happen.

Administrator Suzanne Bierman, during a meeting of the Legislature’s Interim Finance Committee, said that the Medicaid program is still experiencing significant case growth amid economic upheaval because of the coronavirus pandemic. Because of that uncertainty, she said Medicaid might not know until closer to the end of the fiscal year, in June 2021, what funding is available to restore the cuts.

“I think as more time elapses and we’re closer to the end of the fiscal year, we’ll definitely have a more certain projection in terms of what, if any, additional funding is available for that purpose,” Bierman said.

Last month, lawmakers approved a 6 percent across the board Medicaid rate reduction during a special legislative session dedicated to balancing a billion dollar shortfall in the state’s budget. In total, the rate cut is expected to save the state $53 million over the next fiscal year.

However, providers remained hopeful that Medicaid would soon be able to reverse those cuts after the federal government extended enhanced matching funds to state Medicaid programs through the end of the year, expected to generate an additional $30 million in revenue in Nevada.

Ahead of a hearing on the rate decreases last week, the professional associations representing doctors, hospitals and assisted living facilities wrote a letter to Bierman asking why a restoration of the cuts wasn’t on the table though Medicaid had suggested it would be during the session.

“Given the receipt of additional Enhanced FMAP and a balance forward of $57 million in the Medicaid budget, why are rate reductions being imposed? Why is Nevada Medicaid moving forward with implementation when it indicated in testimony that provider cuts would be delayed?” the associations wrote in the letter.

Bierman, during the meeting on Thursday, said that Medicaid’s budget was still too volatile.

“I can tell you based on our actual caseload, just since last month when we were at the special session, we reported that caseload had increased 9 percent pre-COVID and now we're up to 11 percent,” Bierman said. “So, we are seeing very real increases in our caseload even just over the course of that one month since we last discussed this topic.”

Assemblywoman Maggie Carlton, who chairs the Interim Finance Committee, suggested that Medicaid could see significant case growth after Oct. 1, with a number of businesses reporting to the Department of Employment, Training and Rehabilitation that they will be conducting permanent layoffs. Among those is HMSHost, the vendor for food service employees at McCarran International Airport, which has announced that 940 furloughed workers will be permanently laid off by mid-October.

Bierman said that Medicaid, in partnership with the Division of Welfare and Supportive Services, is preparing for a significant increase in Medicaid applications. She said Medicaid is also working with managed care organizations, the insurance companies that provide Medicaid services for a flat, per-person fee paid by the state.

“This is on the radar and also something that we're thinking about ... once eligibility is established, how do we promote continuity of care and make sure that coverage is not only provided but also available and accessible?” Bierman said.

Assembly Republican Leader Robin Titus raised separate concerns about the impact of managed care organizations on Medicaid’s budget. She noted that although Nevada Medicaid reported decreased utilization at the beginning of the pandemic as people stayed home, it continues to pay insurance companies a flat fee to provide care to Medicaid recipients in the state’s two urban counties.

“Every person that is enrolled in that managed care organization, whether they receive one day of care or not, it's costing money because now you're paying that managed care organization per person enrolled,” Titus said.

Bierman said that Medicaid is in the process of working with those insurance companies to renegotiate rates. Once those rates are determined to be actuarially sound, they will go to the Centers for Medicare and Medicaid Services for approval.

“Right now we have utilized that funding to help avoid a shortfall and absorb the costs associated with increased caseload,” Bierman said.