Nevada hearing authorizes pursuit of federal Medicaid waiver for Las Vegas recuperative care center

The Senate Finance Committee heard testimony on Senate Bill 54 on the City of Las Vegasrecuperative care center and a request to allow Medicaid reimbursement for medical respite services.

Randy Ravison, director of government affairs for the City of Las Vegas, told the committee the center provides space for people experiencing homelessness to recuperate after hospital discharge and that the bill "would authorize them to pursue a waiver from the federal government to provide medical respite care ... and have some of those services covered by Medicaid." Ravison said the city amended the bill in policy committee to delay the effective date to remove a fiscal impact in the current biennium and later agreed to push the effective date to July 1, 2027 so the bill would "completely remove[] the fiscal note but still authorize[] them to pursue the waiver."

The bill would not directly appropriate state funds in the current biennium, Ravison said, because state fiscal estimates and the timing of federal waivers make reimbursement unlikely in the short term. He described the center as a post-discharge setting for homeless patients who otherwise would be returned to the street, often reopening a pattern of repeated emergency-room visits. "When they're at our facility, an average stay's about 60 days," Ravison said, adding the center provides intensive case management aimed at linking residents to transitional housing, supports and employment.

Stacy Weeks, administrator for Nevada Medicaid, explained the waiver process and fiscal implications. "The goal here is to get the waiver over the biennium, which will take at least 2 years," Weeks said. She told the committee other states have secured similar waivers: "Yes. Our understanding is at least 4 other states have approved waivers. There are 5 pending," and Medicaid would provide a federal match if the waiver is granted.

Committee members pressed city and state officials on costs and funding sources. Senator Neal asked why the city had used American Rescue Plan Act (ARPA) capital funds to expand the facility rather than planning for operating costs. Ravison replied that the roughly $7 million expansion was capital funding and could not legally be used for operations without a reallocation, and that expansion responded to regional demand and the unique services the center provides in Southern Nevada. When asked about a fiscal-note figure referenced in the hearing, Weeks said the reprinted fiscal estimate showed roughly $8.5 million as an effect on future biennia, and that Medicaid does not pay room and board, increasing operational costs.

Supporters included the Nevada Primary Care Association, represented by Sabrina Schnur, who said federal qualified health centers are doing similar work and supported the bill. Opposition testimony came from Joshua Skaggs, legislative affairs director for the Nevada Republican Party, who said the bill was "poorly defined" and warned the state could be left covering substantial costs if federal participation was less than full. "Due to potential for significant expense to the state of Nevada for services not related to the core Medicaid mission, we ask that you please vote no on SB 54," Skaggs said.

The committee closed the hearing without a recorded committee roll-call vote on SB 54. Members asked staff and agency representatives follow-up questions about the timeline for a federal waiver, eligibility definitions and which services Medicaid could cover if a waiver were approved.

Why it matters: proponents said federal matching funds could reduce repeated emergency-room use and improve recovery outcomes for a vulnerable population; opponents warned the state could be exposed to multi-year costs if federal participation changed.

The hearing record shows officials agreed the waiver process typically takes multiple years and that the bill, as amended, delays implementation to avoid immediate fiscal effects while allowing agencies to seek federal approval.