Nevada officials outline Medicaid enrollment, managed care expansion and waiver limits

At a meeting of the Nevada Assembly Committee on Health and Human Services in Carson City and Las Vegas, Stacy Weeks, administrator of the Division of Healthcare Financing and Policy, and Kelly Cantrell, deputy administrator of the Division of Welfare and Supportive Services, gave a high-level overview of Nevada Medicaid, its coverage rules and related social services programs.

Weeks said Medicaid "covers 1 in 4 Nevadans and about 1 in 2 births in the state," and emphasized that the program is funded jointly by state and federal dollars and is the state’s payer of last resort. She told the committee that Nevada’s Medicaid enrollment is roughly 800,000 people and noted the state receives an approximate 60/40 federal–state match for many Medicaid expenditures.

The presentation explained who Medicaid covers and how services are delivered. Weeks listed covered groups as low-income adults up to age 64, children through age 21, pregnant women and newborns, most seniors 65 and older, people with disabilities, and certain youth in foster care or juvenile-justice settings. She described differences between Medicare (federal program for older adults and some people with disabilities) and Medicaid (joint federal–state program that covers long-term care and many home- and community-based services).

Weeks described Nevada’s delivery system split between fee-for-service and managed care. She said managed care now covers about 75 percent of Nevada’s Medicaid population and that the division plans to expand managed care statewide on Jan. 1, 2026, adding roughly 75,000 people; after that transition, fee-for-service will remain primarily for seniors, people with disabilities, waiver recipients and child-welfare populations.

The administrators reviewed enrollment pathways including Access Nevada, presumptive eligibility in hospitals, district offices and a proposed governor’s budget item to enable "real-time enrollment and plan shopping" for managed-care enrollees so beneficiaries could immediately select a plan and know their benefits.

Weeks and Cantrell summarized optional state benefit choices and waivers. Weeks cautioned that federal approvals for Medicaid waivers can take 18 to 36 months or longer and said waivers must be budget-neutral to the federal government. She described recent waiver approvals in Nevada that add substance use treatment and serious mental illness coverage and limited adult dental for specific populations served by participating federally qualified health centers. Weeks also said the governor’s budget proposes adding a basic adult dental benefit for all adults in the program.

Cantrell described related social services administered by her division, including SNAP (food assistance), TANF cash assistance, energy assistance, childcare programs, child support services and a targeted outreach partnership (TOP) that sends eligibility staff into community sites to accept applications and, in some cases, issue EBT cards on the spot. Cantrell said the division’s programs together serve over 900,000 Nevadans and that about 50 percent of DWSS applications are approved at the first interaction. She told a personal story about a relative with a congenital heart condition and said, "my family would not have been able to cover the cost of his care without Medicaid."

Committee members asked about adult dental expansion, TOP outreach, how rates are reviewed and the effect of managed-care expansion on people with disabilities. Weeks said restoring adult dental requires adding preventive and diagnostic services to secure CMS approval and that rate-setting is an ongoing process involving thousands of billing codes and typically requires funding through the legislative budget process. She told Assemblymember Jackson that individuals who are deemed disabled will remain in fee-for-service and will not be moved into managed care under the current plan.

The presentation closed and the committee moved to two subsequent bill hearings.

Ending: The briefing provided committee members with enrollment thresholds, delivery changes and potential benefit expansions to inform forthcoming bill hearings and budget deliberations. Lawmakers were told waiver timelines remain lengthy and federal approvals can drive implementation timing.