Nevada next year will begin losing out on hundreds of millions of dollars in supplemental Medicaid payments to the state’s hospitals, thanks to President Donald Trump’s “One Big Beautiful Bill Act”.
That is just one of the impacts administrators warned lawmakers the state will have to reckon with next year when setting the state’s next biennium budget.
More than 147,000 Nevadans on Medicaid are set to be affected by the “One Big Beautiful Bill,” or H.R. 1, due to new work requirements for adults without children, limits on coverage eligibility for lawful immigrants, and higher co-pays for adults without children that begin Jan. 1 2027.
Ann Jensen, the Nevada Medicaid administrator, told lawmakers that 70,000 people could lose Medicaid coverage, an estimate she gave based on other states that have reported a 50% drop off.
Nevada already has the sixth highest uninsured rate in the nation, according to KFF. With the estimated 70,000 losing Medicaid coverage, the total number of uninsured Nevadans would reach almost 500,000.
“We are about to step into an economic crisis with the amount of Nevadans that are going to be uninsured and kicked off of Medicaid in the coming years,” Nevada State Sen. Fabian Doñate, a Democrat, said during the legislative Joint Health and Human Services committee meeting. “There is no proposal that I am seeing right now to help with the coverage gap.”
Doñate suggested the Nevada Health Authority (NVHA) and Legislature look at what it can do to keep people insured. He suggested there may be options through the state’s public option plans.
NVHA Director Stacey Weeks noted that states are waiting on federal guidance due in June on how to proceed. “What we’ve seen from this federal administration is that if they don’t like a state funding a subsidy for a certain population, they will put it in guidance that if you do, you won’t get federal funding,” she said.
The federal bill’s impacts will not be confined to Medicaid, but will ripple throughout the entire Nevada health care system, from hospital operating costs to patient wait times, administrators said.
In 2023, Nevada’s private hospitals agreed to pay what’s known as a provider tax, a supplemental payment program that funds Medicaid and helps the state access additional federal matching dollars. The current rate brings Nevada around $830 million each year.
This will change with the passing of H.R.1, which capped the provider tax rates states are allowed to charge.
Nevada Hospital Association CEO Patrick Kelly told lawmakers last month that payment amounts are estimated to be reduced by $300 million in fiscal year 2028 and $507 million in fiscal year 2029. Nevada’s Fiscal Year 2028 begins in July 2027.
Fifteen percent of the provider’s tax is allotted to behavioral health services that address mental health access in the state.
“The overall impact is that we’re going to see a lot more uninsured people, and this is going to increase our uncompensated care costs.” said Kelly, adding that unreimbursed care costs for hospitals is already half a billion dollars annually.
University Medical Center CEO Mason Van Houweling highlighted that UMC relies on federal reimbursement as nearly half of their total inpatients use Medicaid. These supplemental reimbursement payments make up 34 percent of UMC’s total revenue.
Houweling told lawmakers that emergency departments will see the biggest impact with longer wait times due to non-emergency visits. Houweling listed the options that hospitals will have to consider as pressure is put on the hospital’s margins: reducing or eliminating services, cutting staff, and delaying replacement of equipment.
Medical centers that are designed to provide care for Medicaid and uninsured patients will be hit hard as well.
Federally Qualified Health Centers (FQHC) are required by federal law to serve all patients, regardless of their ability to pay.
In 2024, FQHCs served 128,000 Nevadans, 30% of which were uninsured and 39% covered by Medicaid.
“We’re dealing with a wide range of uncertainty,” said Steve Messinger, the policy director of the Nevada Primary Care Association, an association of health centers and other community health providers.
Messinger estimated that 13,000 FQHC patients could lose Medicaid coverage, which would lead to Nevada FQHCs losing $17 million per year, or 11% of their operating revenue.
This would increase the total of uninsured patients to 40%, which is not sustainable for most of the members of Nevada’s FQHC network, Messinger said. Without a replacement in Medicaid reimbursement and increased uninsured patients, overall services will be reduced.
“We can’t afford to keep seeing so many people that are uninsured, so we end up seeing fewer people overall,” he said.
An 11% loss in operating revenue, he added, translates to an estimated loss of 107 full-time jobs across Nevada’s FQHC network.
Messinger highlighted that the uncompensated costs will ultimately fall on privately insured families and Nevada’s employers.
“At the end of the day, there’s only so many people who are able to pay,” he said. “That’s your private insurers, that’s your employer’s premiums and employee premiums. That’s where we would expect a rise in uncompensated care to show up for the rest of us.”
“We must decide whether uninsured residents receive care in costly emergency rooms or cost-effective FQHCs and fund accordingly,” Messinger said.
[Editor’s Note: This article has been corrected to reflect that the Nevada Primary Care Association is an association of health centers and other community health providers. It does not operate medical facilities.]