Nevada Sens. Jacky Rosen and Catherine Cortez Masto. (Photo by Kevin Dietsch/Getty Images)

Policy, politics and progressive commentary

Nevada U.S. Democratic Sens. Jacky Rosen and Catherine Cortez Masto called on Secretary of Health and Human Services (HHS) Xavier Becerra to improve tribal access to federal mental health services via a letter sent on March 14. 

The Indian Health Service is “the agency tasked with providing direct public health support to members of Tribal communities,” the senators wrote. But multiple agencies within Health and Human Services (HHS) “are involved in broadly addressing mental health needs and suicide prevention,” the added.

The senators called on those agencies “to work on increasing Tribal access to their mental health programs and services, to make a renewed commitment to improving culturally appropriate consideration when developing HHS mental health programs and research initiatives, and to take additional steps to make care and research more culturally competent and inclusive, using direct consultation with Tribal communities on how to do so.” 

“Tribal communities have among the highest rates of suicide and mental health needs in Nevada and across the nation, yet access to robust and culturally competent care for Tribes lags behind other communities in the United States,” the senators wrote in the letter. “According to the Nevada Indian Commission, one of Nevada’s Tribal nations recently experienced a suicide cluster that left twenty-one children without a parent.”

The death rate from suicide for American Indian and Alaska Native adults is about 20% higher as compared to the non-Hispanic white population, but access to mental health services is limited due to the rural and isolated location of many Tribal communities. 

“Like so many Native American communities, our Tribal Nations in Nevada have been irreparably scarred by suicide,” said Stacey Montooth, the executive director of the Nevada Indian Commission, in a statement endorsing the senators’ letter. “For the first people of this land, intergenerational trauma coupled with daily hardships of reservation life, especially for our young people, have created unbearable situations for which taking one’s life is commonplace. We know that Indigenous people have disproportionately higher rates of mental health problems such as suicide, post-traumatic stress disorder, violence, and substance use disorders, but with innovative approaches that are culturally competent we can address this.” 

“Tribal communities across Nevada have felt the impact of this mental health crisis, and it’s clear we need new solutions and resources,” said Angie Wilson, Director of the Reno-Sparks Indian Colony Tribal Health Center, in a statement endorsing the senators’ letter to the HHS. 

The senators’ letter called on HHS to explain how the programs the department oversees are culturally competent, how they are reaching out to Tribal nations to ensure that they are aware of federal funding for mental and behavioral health services and programs, and how the funds are awarded.

The letter also asked Becerra to identify changes in federal law that would make mental health programs administered by HHS more inclusive and available to tribal communities.

And the senators called on HHS to detail how it is implementing the national suicide hotline, 988 tribal response cooperative agreements through the Substance Abuse and Mental Health Services Administration, including a list of states that were awarded federal funding to implement it, states that applied and did not receive any, and states that did not apply. 

Suicide is preventable, the national hotline for suicide prevention is 988. 

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“Housing and healthcare go hand-in-hand,” said Nevada Medicaid Administrator Stacie Weeks. “It’s a fact that a person’s overall health and wellness are impacted by where they live.” (Photo: Ronda Churchill/Nevada Current)

Policy, politics and progressive commentary

Nevada Medicaid recently received federal approval to use funds to cover housing and supportive services through Medicaid’s managed care providers. The pilot program will help an estimated 20,300 Nevadans who had identified themselves as homeless when applying for Medicaid. 

As the state implements the program, it is also seeking approval from the federal government to cover housing and other support services for a broader range of Nevadans on Medicaid, via a new Centers for Medicaid and Medicare Services (CMS) waiver opportunity called Section 1115.

Nearly 1 in 3 Nevadans  – 882,000 people – are covered by Medicaid, a joint state and federal program that provides health insurance for low-income individuals or those with disabilities.

“Housing and healthcare go hand-in-hand,” said Nevada Medicaid Administrator Stacie Weeks. “It’s a fact that a person’s overall health and wellness are impacted by where they live.”

Benefits under the pilot program “are a small piece of the puzzle to improve health outcomes and lower the risk of high health care costs that can come from being unhoused,” Weeks said. 

Every state bordering Nevada except Idaho is experimenting with using Medicaid to fund housing.

Arizona, California, and Oregon have been approved for the new Section 1115 Waivers. Utah was approved to provide housing and nutrition services before the Health-Related Social Needs framework implementation under the Biden administration, according to KFF. 

Nationwide, half the states have either begun programs to include housing within Medicaid coverage or, like Nevada, have begun moving in that direction.

Under the Section 1115 waiver Medicaid will cover the cost of rent, temporary housing, and utilities for up to six months, and up to three meals per day for six months. Both contrast with the longstanding prohibitions on Medicaid paying for “room and board.” 

Nevada has attempted to fund housing and supportive services through Medicaid before, but the scope of the legislation was narrower. In 2019, legislators passed a bill that would have allowed Medicaid to provide housing services for behavioral health needs. But the state “ran into some state and county administrative challenges” implementing the bill because of  “federal constraints and requirements for that benefit,” Ky Plaskon, the public information officer for Nevada Medicaid, said via email.

Instead, the Division of Health Care Financing and Policy, which oversees Nevada Medicaid, shifted its focus to join the other eight states moving forward in getting the Section 1115 waiver. 

The bulk (78%) of Nevada Medicaid recipients are covered by managed care plans, which are private insurance companies Nevada Medicaid contracts with. The remaining are covered through a fee-for-service model in which the state pays Medicaid providers directly for each covered service. 

In addition to help with rent and food, the services covered under the new pilot program will include specialized case management, housing transition services, and housing-related deposits. 

Before the pilot program can begin operating, the four Medicaid managed care plans – Anthem Blue Cross and Blue Shield Healthcare Solution, Molina Healthcare of Nevada, SilverSummit Healthplan, and UnitedHealthcare Health Plan of Nevada Medicaid – will have to submit plans to cover the services to CMS for approval. The companies are expected to submit their plans to cover the services by the end of March. 

The four managed care providers for Nevada Medicaid did not respond to inquiries about whether they already provide housing and other wraparound services by the deadline.

“Nevada Medicaid is still exploring how best to implement these services for the state’s fee-for-service population in Medicaid under federal law,” Plaskon said via email.

The state’s Division of Health Care Financing and Policy anticipates completing the Section 1115 waiver to provide housing and other services to a broader portion of Medicaid recipients by the end of the year.

“Seeking federal approval through the waiver authority should allow Nevada Medicaid to accomplish the same benefit structure for housing supports and services along with meal services for those experiencing homelessness or at risk of homelessness due to a behavioral health condition across both fee-for-service and managed care,” Plaskon said via email. 

Those covered by the managed care plans can contact the plans directly to learn about the types of housing support and meal services available. 

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Direct File allows eligible taxpayers to file directly with the IRS, avoiding hidden fees that come with other ostensibly free options, including Free File, the public-private partnership between the IRS and tax filing software industry giants. (Photo by Chip Somodevilla/Getty Images)

Policy, politics and progressive commentary

The U.S. Department of the Treasury and the Internal Revenue Service launched its new, free tax filing program in Nevada and 12 other states Tuesday. 

Nearly 20 million people qualify for the Direct File program including 480,000 Nevadans, according to the Treasury Department release.

In Nevada and the dozen other states participating in the Direct File pilot program, eligible taxpayers include those whose incomes include W-2s,  unemployment benefits, interest up to $1,500, and people with social security income. 

“Direct File will offer millions of Americans a free and simple way to file their taxes, with no expensive and unnecessary filing fees and no upselling, putting hundreds of dollars back in the pocket of working families each year, consistent with President Biden’s pledge to lower costs,”  said National Economic Advisor Lael Brainard, in a statement announcing the launch.  

Annually, taxpayers in the U.S. spend 1.7 billion hours and $31 billion on tax preparation, with the average person spending 13 hours and $270 to file, despite the bulk of people having simple tax cases and qualifying for free programs.

Direct File allows eligible taxpayers to file directly with the IRS, avoiding hidden fees that come with other ostensibly free options, including Free File, the public-private partnership between the IRS and tax filing software industry giants. 

Those companies have come under scrutiny for embedding misleading practices in the Free File process like charging tax filers additional and unnecessary fees. 

A ProPublica investigation found that companies like Intuit used code to make the Free File landing page on TurboTax hidden on search engines, charged for other products that were not free or for commonplace tax forms, and only disclosed the paywall pop-up for these extra charges when the taxpayer was already deep into the filing process.

The Inflation Reduction Act funded the Direct File pilot program as part of $80 billion for the IRS to address severe understaffing, modernize outdated technology, and enhance enforcement. The IRS will use $15 million of IRA funding to implement and monitor the new pilot program. 

Direct File, the new program, is not available for those whose income is from a personal business or gig economy employment, who have itemized deductions, or who use the Saver’s Credit or Premium Tax credits.  

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Nevada Democratic Sen. Sen. Jacky Rosen during a Senate committee hearing last month. (Photo by Anna Moneymaker/Getty Images)

Policy, politics and progressive commentary

Nevada Democratic U.S. Sen. Jacky Rosen announced Monday that $1.34 billion in funding for tribal housing programs is now available, including for the Indian Housing Block Grant program. 

The funding was included in the government spending package approved by Congress and signed into law last week. 

Native Americans in tribal areas have some of the worst housing needs in the nation, facing higher poverty rates, overcrowded housing, lack of plumbing and heat, and limited infrastructure for sewer, gas, and energy, according to the National Low Income Housing Coalition (NLIHC).  

Rosen last month urged the Senate Appropriations Committee to increase funding for tribal housing, specifically by reauthorizing the Native American Housing Assistance and Self Determination Act (NAHASDA).

Originally enacted in 1996, NAHASDA is the primary federal statute to address housing in tribal communities, including the Indian Housing Block Grant program, the Native Hawaiian Housing Block Grant program, and the Title VI Loan Guarantee program.

Yet Congress had not officially reauthorized the act since 2013, and program funding has been largely stuck at funding levels that were set then. As a result, when adjusted for inflation, funding for tribal housing has actually decreased over the last several years. 

Nevada is home to 28 Tribes, bands, councils, and colonies, many of which received grants through the Indian Housing Block Grant program to build affordable housing. 

“As we confront a housing shortage and affordability crisis, Tribal communities in Nevada are being hit particularly hard,” Rosen said in a statement announcing the funding. “That’s why I pushed for increasing funding for housing in Tribal communities in the bipartisan government funding package.” 

“Thanks to the strong leadership of Senator Rosen, together we’re delivering record funding for Native communities in Nevada and across the country. This funding will help support unique and urgent Native housing needs, including building more affordable housing, providing rental assistance, and getting electricity and plumbing into homes,” said U.S. Senator Brian Schatz, Chair of the Senate Committee on Indian Affairs.

This story has been updated to include a quote by U.S. Senator Brian Schatz, Chair of the Senate Committee on Indian Affairs.

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County officials intend for new facility to help provide emergency behavioral care alternatives to ERs and jails. (Photo courtesy Cushman & Wakefield)

Policy, politics and progressive commentary

Clark County purchased a 24-bed psychiatric hospital for $10.4 million this week. It plans to turn the property into a crisis stabilization unit pilot program to open later this year, according to Clark County Deputy Manager Abigail Frierson. 

Crisis stabilization units are small facilities that offer short-term behavioral health care including psychiatric stabilization and substance withdrawal treatment in a place that is less restrictive and less disruptive to a person’s life than a hospital or jail.  

“There’s not a lot of opportunity to get emergency behavioral health care in the Valley so often people will have to go to the emergency room and in certain circumstances, they would have to go to jail,” and the new facility will provide a needed alternative, Frierson said.

Nevada ranks at the bottom of all states in access to behavioral health care services and has a higher prevalence of mental illness, according to the nonprofit Mental Health America’s annual rankings. People throughout the state are often forced to use emergency rooms or wait for jail-based services because other services aren’t available.

“Traditionally, behavioral health is not something the county administers, that’s more in the purview of the State of Nevada, but we did see that this was a need in the Valley, an unmet need. In partnership with the State of Nevada, we decided to move in this direction,” Frierson said.

The program will be funded through partnerships between the state and the county. The state will reimburse Clark County for part of the purchase price of the facility and services will be funded through insurance and the county, she said.

The program would be in addition to the state’s efforts to bring crisis stabilization centers on board per federal guidelines for the 988 program’s initiative to build a behavioral health infrastructure for people in crisis – “someone to call, someone to come and somewhere to go.”

While Nevada was initially one of only a handful of states to fund the 988 crisis line, it has faced delays in getting that funding, finding staffing, and has struggled to provide multilingual access. Delayed funding in particular has pushed back the state’s efforts in implementing the other two requirements of the federal government for the 988 program: mobile crisis teams to come to people in need of help, and crisis stabilization centers to provide care. 

“This works adjacently with 988,” Frierson said, noting that “as a pilot, I don’t think that this facility can handle all the need in the Valley. ”

The building, located in North Las Vegas, was completed in 2021, but never used. Frierson some small changes will need to be made to the facility, and the county also needs time to recruit staff and obtain licensing. 

After the one year pilot program ends, the county will decide if it is feasible for it to continue, Frierson said.

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The Reno Sparks Tribal Health Center. (Photo: Reno-Sparks Indian Colony, rsic.org)

Policy, politics and progressive commentary

The Reno Sparks Tribal Health Center announced its designation Thursday as a Tribal Federally Qualified Health Center, which allows it to pay higher reimbursement rates to specialists providing care. The designation is in collaboration with the Nevada Department of Health and Human Services.

“Tribal patients will have an easier time accessing care, and I hope it will help all those who suffer from chronic diseases,” said Reno-Sparks Indian Colony Chairman Daryl D. Gardipe, in a statement announcing the partnership. 

Centers for Medicare and Medicaid Services approved the designation, which allows the Reno Sparks Tribal Health Center to negotiate payment rates with specialist providers that are higher than the typical Nevada Medicaid payment rates. 

The designation, combined with CMS reimbursing Nevada Medicaid at 100% for all services provided to Native Americans in the state, means it will cost less for the specialist providing the care and Nevada Medicaid will be reimbursed more by CMS.  

“This designation is a win-win,” Angie Wilson, the Reno-Sparks Indian Colony Tribal Health Center Director, said in a press release. “It will benefit patients seeking care, providers managing their business, our Tribe as we work to improve the health of the community, and as a savings to the State budget.”

Reno Sparks Tribal Health Center is Nevada’s largest tribal health center, providing care to approximately 6,000 patients. 

Native Americans have worse health outcomes in diseases that often require specialists to treat such as diabetes, cirrhosis, chronic lung diseases, as well as behavioral health illnesses and issues, but often face systemic barriers in access to care including inadequately staffed facilities. 

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The report documents the ongoing struggles Nevada has with access to health services, and identifies policy goals that could be implemented to improve the state’s performance in those areas. (Getty Images)

Policy, politics and progressive commentary

Nevada’s first-ever statewide “health improvement plan” examines inadequacies that have long bedeviled the state, and makes several policy recommendations designed to improve the health of Nevadans.

The Nevada Division of Public and Behavioral Health released the plan in collaboration with the University of Nevada, Reno School of Public Health Tuesday. 

The Silver State Health Improvement Plan documents the ongoing struggles Nevada has with access to behavioral health, oral care, public health infrastructure, and social determinants of health that play a role in keeping residents healthy. The plan also identifies policy goals that could be implemented to improve the state’s performance in these areas. 

The plan was born out of DPBH’s desire for accreditation from the nonprofit Public Health Accreditation Board in 2021, a voluntary program designed to help improve public health care in the U.S. 

The Centers for Disease Control and Prevention encouraged all government public health organizations to get accreditation which sets national standards for how government public health organizations should perform.

One condition of the accreditation process was to create a statewide health improvement plan. DPBH met this condition via a partnership with UNR’s Center for Public Health Excellence. 

UNR and DPBH presented some of the plan to the Joint Interim Standing Committee on Health and Human Services earlier this month.

“The plan essentially provides a roadmap for DPBH and community organizations to work together to improve the health of Nevadans,” Megan Comlossy, the director of the UNR School of Public Health Public Affairs and Policy, told legislators during the interim committee. 

State Sen. Fabian Doñate (D-Las Vegas), the vice chair of the committee, pushed for the presentation of the plan to be heard as the interim committee sets its policy goals for the next legislative session.

“This is the ground we currently sit on, we know that there are plenty of issues that can go into health care but we can’t solve all of them in one year or two years, so these are the areas that we should be aligned towards,” he said. 

The 2023 legislative session laid the foundation for some of the goals highlighted in the plan, including addressing Nevada’s long-standing behavioral health provider shortage by passing three bills. The assembly introduced and passed two bills, one that created a behavioral health workforce development center to help develop a pipeline of providers by reducing barriers to licensure, and another that created a student loan repayment program for providers working in underserved communities. The Senate passed a bill extending telehealth requirements helping those living in behavioral health provider shortage areas continue to get treatment. 

But the plan released this month laid out other solutions that can inform policy changes, including joining interstate licensure compacts, which allow behavioral health providers to practice in other states outside of where they are licensed as long as they meet certain requirements. 

The plan was developed with input from nearly 100 people representing state, local, and tribal governments as well as public health, social services, and education organizations. 

It establishes 15 goals that fall under four categories: access to health care; mental health and substance use; social determinants of health; and public health infrastructure.

Some of the 15 goals include:

• Improve access to oral health by supporting school-based sealant programs through American Rescue Plan Act funds. Sealants are thin coatings applied to teeth that can prevent cavities, helping lower-income children prevent costly visits to the dentist.
• Increase access to children’s behavioral health services by allowing schools to bill Medicaid for children’s behavioral health services provided on campus.  
• Reduce food insecurity and improve the overall food security ecosystem by partnering with local farmers, food vendors, tribal communities, and other community organizations to support initiatives aimed at increasing mobile access to healthy foods.
• Invest in the Nevada public health system, which includes the Nevada Department of Health and Human Services as well as local health districts, with funding levels that are flexible and sustainable through an increase in flexible, non-categorical State General Funds. The bulk of funding provided to these public health departments is through short-term grants to be used for specific purposes.
• Increase investment in the behavioral health system in Nevada by increasing the State General Fund investment in Medicaid and use those dollars to raise reimbursement rates for behavioral health services. 
• Improve the quality of Nevada’s public health system by increasing the number of state and local health authorities that are accredited or reaccredited by the PHAB. 

“The State Health Improvement Plan provides a roadmap for state government and community partners to work together to improve the health of all in the Silver State,” DPBH Administrator Cody Phinney said in a statement accompanying the report’s release.

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(Photo: Getty Images)

Policy, politics and progressive commentary

The Nevada Division of Public and Behavioral Health (DPBH) is turning to alternative measures to provide more forensic beds and services after a deal with the City of Las Vegas soured, leaving DPBH to pay a $500 fine  for each day a person in need of mental health treatment is in jail instead of under care. 

The deal would have created 44 new forensic beds at the Las Vegas Detention Center, with $55.4 million in American Rescue Plan Act funds earmarked for the project. Now the state must reallocate those funds by the end of the year or lose them. The state is working to reassign those funds to new programs including those highlighted at the DPBH Commission on Behavioral Health meeting earlier this month that divert people to services outside of forensic hospitals. 

Delays in getting people into forensic psychiatric care can exacerbate mental health conditions. Forensic psychiatric beds aim to provide mental health care in a correctional setting and reduce the risk of recidivism in the least restrictive manner, stabilizing a person who is waiting for their case to be adjudicated or an assessment for competency to stand trial.

As of  Feb. 15, 123 individuals needed competency-related services in jails in Nevada, waiting an average of 103 days from the time they receive a court order for admission to one of the two appropriate state facilities, according to DPBH. 

One of the programs highlighted at at this month’s Commission on Behavioral Health meeting includes a diversion program operated by Lake Crossings, one of the two state hospitals serving court-ordered patients. 

Program staff visits people on the waitlist at Washoe and Clark County jails for alternative services outside of forensic hospitalization, said Drew Cross, the statewide coordinator of forensic programs, during a DPBH Commission on Behavioral Health meeting last week. 

DPBH has also allocated some  $4.9 million of ARPA funding to Stein Forensic Hospital in Las Vegas, the other state hospital providing court-ordered mental health services, to refurbish 20 beds, which should be ready by July 2025, according to DPBH. 

The remaining ARPA funds need to be allocated by Dec. 2024 and used by Dec. 2026, otherwise, the funds will return to the federal government. 

The 2023 Nevada Legislature approved funding to design a new forensic hospital building that is currently slated to add 282 forensic beds. Funding for construction will be considered in the next legislative session, according to DPBH. 

The jail conversion program was originally slated to be ready last summer, state officials told the Legislative Interim Finance Committee in October 2022. 

After delays, DPBH hoped renovations of the jail would be completed by December 2024. But cooperation between the city and state quickly turned to squabbling. DPBH reported that the two government entities “were unable to reach a mutually acceptable lease agreement for use of the jail space.” 

In his 2023 State of the State Address, Gov. Joe Lombardo described the need for additional forensic mental services as “critical,” and noted his budget included funds for the Las Vegas jail conversions as well as upgrades to the Rawson-Neal facility in Las Vegas, which has a portion of its hospital dedicated to forensic beds, and the creation of the new facility in Southern Nevada. 

The governor’s office did not respond to inquiries about the failure of the Las Vegas jail conversion, the fines paid by DPBH, or the delay in creating new beds.

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Consumer advocates warned motorists could face yet another bump to already rising premiums when the temporary regulation authorizing the refund discontinues in May, and called on the state to make it permanent. (Photo: Ronda Churchill/Nevada Current)

Policy, politics and progressive commentary

The Nevada Department of Insurance returned $20 million to more than 160,000 drivers in the state whose premiums were increased during the pandemic because of a low or declining credit score. The average return was $127.

But during a state insurance advisory group meeting this week, consumer groups warned that many Nevadans, even those with perfect records, could face yet another bump to already rising premiums when the temporary regulation authorizing the refund discontinues in May, and called on the state to make it permanent. 

Nevada has some of the highest car insurance premiums in the nation.

During the first year of the pandemic, DOI determined that insurers’ credit score-based premium increases were discriminatory and violated state law. DOI implemented a regulation in December 2020 that prohibited companies from increasing any auto customer’s premium due to credit score drops during the pandemic, and required auto insurers to refund them. 

Michael DeLong, a research and advocacy associate at the Consumer Federation of America, said that the state should consider making the temporary regulation permanent and bolster protections for consumers from discriminatorily higher insurance rates. 

“State legislators need to step in, not only to continue the protection that refunded consumers $20 million but to prevent other industry strategies that punish drivers simply because of their socioeconomic status. That would not only prevent further financial pain; it will help people avoid being priced out of coverage and possibly having to drive uninsured, which puts everyone at risk,” DeLong said.

The temporary regulation was fully effective in February 2023 after the Nevada Supreme Court rejected an insurance industry challenge to the regulation. 

Advocate organizations noted that in addition to credit scores, other data sources insurance companies use to determine rates can lead to unfair discrimination, and encourage Nevada legislators to pass a law similar to one Colorado passed in 2021 that requires those data sources to be tested for bias against race, ethnicity, sexual orientation or faith. 

“The pandemic made clear that one type of data used by insurers could be unfair and unfairly discriminatory,” said Birny Birnbaum, executive director of the Center for Economic Justice, in a statement. “In the case of consumer credit information, the pandemic resulted in different prices for consumers with the same risk profile  — the actuarial definition of unfair discrimination. Insurers should be required to routinely test  these non-traditional sources of data for unfair discrimination and racial bias.”  

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"A lot of folks on Medicaid may not have a home, may not be able to get to the post office, and may not be able to return" Medicaid renewal forms from the state, said state Sen. Robin Titus. (Getty Images)

Policy, politics and progressive commentary

Nevada legislators are expressing frustration over the state’s inability to track people who were wrongfully disenrolled from Medicaid last year.

“People are transient, and they list an address but it’s not exactly where they live, and we as government officials will send out government notices saying ‘hey you need to fill out this form’ but they might not even receive it,” state Sen. Fabian Doñate, chair of the Interim Committee on Health and Human Services, during a meeting last week.

Nevada had one of the nation’s highest Medicaid disenrollment rates due to procedural causes like missing paperwork during the process of unwinding a federal policy designed to keep people covered under Medicaid during the pandemic. As a result, 114,000 Nevadans lost their health care coverage, only to have it reinstated months after the Centers for Medicare & Medicaid Services (CMS) intervention.  

Lawmakers on the interim committee sought explanations from the Division of Welfare and Supportive Services (DWSS) about how the state tracks people who may still qualify for Medicaid, but who haven’t been re-enrolled.

Vulnerable populations who are often eligible for Medicaid may be experiencing homelessness, facing language barriers, lacking access to transportation, or dealing with other conditions that prevent them from filling out the re-enrollment packet mailed to them, returning it, or even receiving it in the first place, said Republican state Sen. Robin Titus.

“I’ve been at this in the past and just the accessibility of getting those applications returned. A lot of folks on Medicaid may not have a home, may not be able to get to the post office, and may not be able to return those,” Titus said. 

Despite the ongoing concerns that procedural terminations still disproportionately impact marginalized and at-risk populations that have plagued the unwinding process, there is no data on what’s happening to those who have to fill out the packets but don’t. 

“Are there metrics that our state has gathered post unwinding to make sure that those folks [aren’t disenrolled] as a mistake?” asked Doñate, who chairs the committee.

“We are not currently gathering or surveying members as to why they’re falling off the rolls,” said Sandie Ruybalid, deputy administrator of the Nevada Department of Health and Human Services Division of Health Care Financing and Policy. 

“Some states are doing that, but we don’t have the resources at this time to perform that kind of outreach,” Ruybalid said.

At the start of the unwinding process, 80% of Nevadans enrolled in Medicaid were disenrolled from Medicaid because of procedural causes, one of the highest in the nation. Most of them were renewed automatically through a new system. 

About 12% of those have been terminated, said Kelly Cantrelle, the deputy administrator for DWSS, at the meeting. State date indicates in the last 12 months, 22,914 Nevadans have been disenrolled from Medicaid and not reinstated.

CMS paused disenrollment for procedural causes after it found that Nevada and most other states had “state systems issue” that led to “inappropriately disenrolling children and other enrollees, even when the state had information indicating the person remained eligible.” 

Older adults, people who have moved, immigrants, people with disabilities, and people with limited English proficiency are at an increased risk of losing Medicaid coverage or experiencing a gap in coverage due to barriers to completing the enrollment process, according to a KFF brief.

Procedural disenrollments resumed in January, and Nevada’s unwinding process is estimated to end in September,  Cantrelle told the committee.

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