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State ombudsman, ADSD and Medicaid officials warn of severe long-term care capacity gaps and staffing shortages
Summary
Presentations to the Silverhaired Legislative Forum highlighted over 25,000 people on the Frail & Elderly Medicaid waiver waitlist, thousands of care-related complaints in 2025, and workforce shortages; Medicaid described a $16 minimum-wage mandate for Medicaid-paid caregivers and audit steps to enforce pass-through.
State ombudsman and Medicaid officials told the Silverhaired Legislative Forum on Thursday that Nevada faces significant long-term care capacity challenges: large waiver waitlists, rising complaints about unmet care needs, and a shortage of direct-care workers that threatens quality and access.
"In 2025, there were over 4,000 complaints statewide regarding care concerns," said Marie Co, Nevada’s state long-term care ombudsman, citing trends including late medication administration, unmet bathing or toileting needs and unsafe discharges from rehabilitation settings.
Waitlists and timing: ADSD reported that the Frail & Elderly Medicaid waiver has about 25,536 people waiting for slots and the Physical Disabilities waiver about 638 — wait times that now can exceed two years even after prioritizing highest-need applicants. State-funded programs (COPE and personal assistance) showed comparatively smaller waitlists.
Workforce pressures and pay policy: Officials emphasized that recruitment and retention of direct-care workers remain the central challenge. Nevada Medicaid then described a post-pandemic suite of actions including supplemental payments and a Medicaid-anchored minimum wage requirement: providers seeking higher Medicaid reimbursement must pass a $16 minimum hourly pay to direct-care workers receiving Medicaid-funded personal care services. Kirsten Koulam (Nevada Medicaid) said the state established auditing processes through the Nevada Health Authority’s Office of Inspector General to verify that providers pass the $16 to workers and to take corrective action where needed.
New program planning: Medicaid is also standing up Program of All-Inclusive Care for the Elderly (PACE) through a competitive procurement; officials said successful providers will need time to establish sites and interdisciplinary teams, and the earliest Nevada enrollment of PACE recipients is likely in 2028. Officials also reported progress on a structured family caregiver waiver and initial provider enrollments.
What members asked: Forum members pressed for the source of wage standards, whether wage levels match market demands and how many direct-care workers the state needs. Presenters confirmed that the $16 wage requirement applies to Medicaid-paid services (not all home-care jobs in the private market) and said the figure emerged from provider, caregiver and recipient input during post-COVID stakeholder work.
Policy context and possible responses: Presenters and several members discussed multi-sector planning (state-level “multi-sector plan on aging”), expanded volunteer networks (transportation and social connection) and targeted prevention to reduce avoidable institutionalization. Members asked that the forum continue engaging on staffing standards, waiver capacity and funding levers needed to reduce long waitlists.
