Nevada health officials are preparing to phase in sweeping new work requirements for the largest safety-net insurance program in the state, a move that will impact an estimated 280,000 Nevadans who benefited from expanded Medicaid coverage.
Under the tax and spending law President Donald Trump signed a year ago, Nevada and other states that expanded Medicaid to cover more low-income adults under the Affordable Care Act will be required to prove that those adults work, go to school or volunteer for at least 80 hours a month to maintain their coverage.
The new requirements — which start Jan. 1, 2027 — only apply to people who gained Medicaid coverage through the expansion between the ages of 19-64. Beneficiaries will also have to reapply every six months instead of once a year.
The Nevada Health Authority is responsible for implementing the Medicaid work requirements, the agency said they are actively working to inform Medicaid recipients of the changes.
Under the new federal law, about 5,000 legally present immigrants in Nevada will be cut from Medicaid regardless of whether they meet work requirements starting October 1, 2026.
“It’s incredibly important that people know if their coverage is changing, and so those notifications have gone out over the past few weeks. And there’ll be more information to come for our community partners on exactly what that looks like,” said Ann Jensen, the administrator for Nevada Medicaid in a workshop last week.
Some groups are exempt from the new requirements, including pregnant people, foster youth up to age 26, veterans with total disability, Native Americans, incarcerated people, those in treatment for drug or alcohol use disorder, and those who are “medically frail.”
However, on June 1 the Trump administration published interim guidelines that narrowed the definition of “medically frail” to a person with a significant health condition who is also impaired in their ability to work.
In July, Nevada and 24 other states with Democratic attorneys general plus the District of Columbia sued the Trump administration over the work requirement, largely on the basis of the changed “medically frail” guidelines.
The guidelines were published only seven months ahead of the deadline for Medicaid work requirements to go into effect, leaving health officials scrambling to implement the guidelines in their plans.
“It was about 300 pages, and our team has spent a ton of time digging into the complexity of this,” Jensen said.
Nevada health officials said after reviewing the new federal guidelines they finalized a policy decision to define “medically frail” as those who fall into one of five medical conditions and are impaired in their ability to work due to that health condition.
Those medical conditions include people who are blind or disabled, have a physical, intellectual, or developmental disability, have a substance abuse disorder, have a disabling mental health disorder, or have a serious or complex medical condition.
“It’s not just that someone, for example, has a serious or complex medical condition, but that that condition impacts their ability to work or to volunteer or to go to school. You can imagine there’s a lot of complexity to what that looks like,” Jensen said during a workshop last week.
The new law will also require new copays for some Medicaid expansion enrollees starting October 2028, the exact amount will be set by federal guidlines and the state.
Following the federal guidelines released last month, Nevada health officials said they would be seeking approval for all four short-term hardship exemptions outlined by the federal government. Those exemptions include Medicaid recipients that must travel far for care, those hit by natural disasters, those living in counties with high unemployment, and those with recent hospital stays.
Health officials said they expect the short-term hardship exemptions to benefit rural communities in Nevada.
Under the new federal law, Medicaid members can self-attest they are compliant with new work requirements in 2027, but will be required to provide documentation starting 2028, according to the Nevada Health Authority.
Officials said they are also working on using all available data sources to determine if someone is exempt or compliant with work requirements in order to require the least documentation possible for Medicaid recipients, which could help keep more Nevadan’s enrolled.
“We are here to serve our members and ensure their full coverage is continuous wherever they’re eligible. Everything we’re doing here is to make that as clear and straightforward of a process as possible,” Jensen said.
Part of that work is helping Medicaid members understand what is changing and what they need to do to retain coverage, including a focus on clear and consistent messaging, said Chloe Chism, a spokesperson for the Nevada Health Authority.
On September 1, the nearly 280,000 Medicaid members who could be impacted by the new federal law will receive emails, texts, and mailed letters with information about the changes. The Nevada Health Authority said they will start outreach media next month.
The agency also has hired more navigators using new grant funding to help partners assist clients facing loss of Medicaid coverage.
“We want to help folks understand what is changing and what they need to do to retain coverage,” Chism said during the workshop last week.
(0) comments
Welcome to the discussion.
Log In
Keep it Clean. Please avoid obscene, vulgar, lewd, racist or sexually-oriented language.
PLEASE TURN OFF YOUR CAPS LOCK.
Don't Threaten. Threats of harming another person will not be tolerated.
Be Truthful. Don't knowingly lie about anyone or anything.
Be Nice. No racism, sexism or any sort of -ism that is degrading to another person.
Be Proactive. Use the 'Report' link on each comment to let us know of abusive posts.
Share with Us. We'd love to hear eyewitness accounts, the history behind an article.