Nevada health exchange requests two staff and $31.6 million in biennial budget as enrollments rise

The Silver State Health Insurance Exchange asked a joint legislative subcommittee on general government to approve two new positions and biennial spending authority as it reported record enrollments and growing operational demands.

Executive Director Russell Cook told the Assembly Ways and Means and Senate Finance subcommittee that the exchange(known as Nevada Health Link or SSHIX) requested a biennial budget that would rise modestly from current levels and would fund two new positions, travel and training, membership fees, equipment replacement and continued reserve holdings. "We are a state-based Affordable Care Act exchange and we operate the online health and dental insurance marketplace, nevadahealthlink.com," Cook said.

The request, Cook said, reflects rising enrollment and new program requirements. He reported nearly 113,000 final plan selections for 2025 (health and dental combined), about 27,000 consumers classified as "new" under federal CMS definitions, and more than 86,000 returning enrollees. Cook said health enrollments rose about 12% in 2025 compared with 2024 and that there was a roughly 4% increase in unsubsidized enrollments. "There were 15,499 consumers with $0 monthly premiums," he added.

Cook told lawmakers the exchange's operating revenue is entirely fee-based, derived from per-member-per-month carrier premium fees; it does not use state general fund or federal appropriations. The agency's request for the first year of the upcoming biennium was presented as "just under $31 million," and Cook gave a second-year figure of $31,625,725 including fees and reserves.

The two personnel requests are: a Management Analyst III to lead plan review and certification, and a Health Program Specialist I to serve as a dedicated tribal liaison. Cook said the Management Analyst III is needed to handle an increasing plan-certification caseload, greater plan complexity linked to Nevadas market stabilization program and the onboarding of carriers offering Battle Born State Plans. "We're looking for this position to absorb not only the extra caseload, but also to serve as a liaison to these insurance carriers," Cook said.

Cook described the tribal liaison position as central to an expanding Tribal Partnership Program. He said the exchange has been working with multiple federally recognized tribes on an aggregated-billing pilot that rolls up many individual premium payments into a single monthly remittance, reducing administrative burden and improving payment stability. The exchange also trains and certifies Tribal Exchange Representatives (TERs) to provide enrollment assistance in tribal communities; Cook noted the program has coincided with a 33% increase in American Indian or Alaska Native enrollments over the last year.

Committee members asked operational questions. Co-Chair Anderson asked how the market stabilization changesincluding carriers offering Battle Born State Plans (BBSPs)would affect exchange operations. Cook said the exchange expects an increased plan-certification workload, new quality and customer-service metrics, and coordination around a reinsurance component tied to an attachment point he said has been discussed at about $50,000 per claim. Cook said the statenot the exchangewill coordinate across agencies on the reinsurance design but that the exchange is preparing for data and operational needs, including anticipated use of an all-payer claims database coming online in 2026.

Assemblymember Backus asked about the requested July 1 start date for the Management Analyst III position. Cook said the exchange would only open recruitment if the position is approved by the Legislature but emphasized the timing is intended to support onboarding before the November open-enrollment period.

Cook also described program-integrity steps: the exchange now requires documentation and verifies 100% of special enrollment period (SEP) applications, he said, as part of efforts to prevent improper use of SEPs and to reduce adverse selection.

The hearing closed with no public commenters in person or on the phone. No formal actions or votes were taken during the session.

The exchange identified continued high reserve balances as a deliberate policy to preserve flexibility when federal rules or subsidy structures change; Cook cited prior changes under the American Rescue Plan Act and recent CMS rule proposals as examples of rapid regulatory shifts that required a financial runway.

Questions to SSHIX staff were taken from subcommittee members including Co-Chair Anderson, Assemblymember Backus and Senator Taylor; Jonathan Lopez, SSHIX finance officer, provided brief technical clarifications during the hearing. Chair Scheibel closed the hearing on budget account 101-1400 and moved to public comment, during which no members of the public spoke.

Looking ahead, the exchange said it will continue implementation work related to Nevadas market stabilization program, tribal partnerships and enrollment outreach. The agency asked the committee for approval of the two positions and the requested biennial spending authority to support those operations.