Starting in 2027, some Nevadans on Medicaid will have to work, volunteer, or go to school to keep their coverage.

That's because of changes in HR 1, the Federal Tax and Spending Law, often called the One Big Beautiful Bill.

Nevada Medicaid now estimates 30- to 50,000 Nevadans could lose coverage in 2027.

States do have some say in how the new rules are carried out, and so we talked with Ann Jensen, Administrator of Nevada Medicaid, to find out what Nevadans need to know.

Our conversation began with what actually happens on January 1.

(Ann Jensen) January 1 is when the requirements begin; but, importantly, they begin for people that newly enroll in Medicaid on or after that day or people that initiate their Medicaid renewal.

So what that means is on January 1, there will be people that receive their Medicaid renewal packet in the mail 60 days in advance of their renewal date, which is March 31st would be the earliest group of people that are impacted by these changes.

In that renewal packet, people may see questions related to work requirements if Nevada Health Authority wasn't automatically able to accept, exempt, or comply them based on data that we already have.

So if we have information about whether someone's already meeting work requirements or if they don't apply to them, then we won't ask any further questions and that packet will look as it normally does.

But starting January 1st there may be an addition to that packet, which would be a screener for work requirements, which would help us collect information that we may not have already and determine whether someone is eligible to maintain their Medicaid coverage.

-So for any Nevadan on Medicaid right now, what should they do?

-Absolutely.

There's two important things that people can do right now to prepare for these changes: first is to make sure their contact information is as up to date as possible with the state so we know where to reach you if we have additional questions or need more information; secondly, we ask people to figure out when their redetermination date is in 2027.

That will help you prepare for when you need to meet these requirements.

If you have any questions on what the requirements are or whether they apply to you, we recommend you go to our website, which is nevadamedicaid.nv.gov.

The top of that webpage, we have a link to a really comprehensive resource on all things Medicaid eligibility changes, including an online kind of screening tool that gives you a non-binding way to provide some information, and it will tell you whether this may or may not apply to you, which is a really helpful planning resource.

We also have online, over the phone, and in-person resources available if you have further questions about your particular situation.

-Who has to meet the work requirements, and who does not?

Who is exempt automatically?

-There's a number of exemptions and exceptions that apply based on federal law and our state policy decisions.

At a high level, it's adults ages 19 to 64 that are not parents or caregivers of young children that otherwise have an ability to work or volunteer.

There's a number of different exclusions, and I won't be able to cover all of them in its comprehensiveness.

And so what's available on our website is a resource that lists every single one of those that will help people evaluate their individual situation.

Our intention is to be as clear and transparent as possible as we evaluate whether someone needs to meet these requirements.

-And simply because you said "caregivers," do you mean of only children, or can you be a caregiver for an elderly parent, for example?

-It's a great question.

There are exclusions.

Parents of children under the age of 14 are automatically excluded.

However, people that have caregiving responsibilities for other family members that relate to their activities of daily life are potentially eligible for what's called a hardship exception.

And so there's a process for people to provide a little bit more information on that and to attest to the fact that that describes their situation, and that would allow them to be excluded from work requirements in 2027.

-What are the work requirements?

What counts?

-Absolutely.

Work requirements is perhaps too narrow of a word to describe it, because there's a number of qualifying activities.

Those include working, of course; education programs such as a GED program or a college program; job training or apprenticeship programs also count as well, as does volunteering.

And so any combination of those activities has to total 80 hours in one month for someone to qualify for their Medicaid coverage to be renewed.

-How does someone keep track of that and report it accurately?

-Absolutely.

First and foremost, we try to use data that we already have.

So we have an ability to review wage data and other employment data to automatically comply someone with these requirements.

We think about 60% of Nevadans that will go through the work requirements process will be evaluated automatically with data, and we won't have to ask them for any more information.

If, for example, someone is qualifying based on a GED program or a volunteer program that we don't have data for, they have an opportunity in 2027 to complete what's called an attestation form.

That's an online or on-paper form that comes as part of the renewal process that guides people through each of our exclusions and kind of compliance activities and asks them to attest whether that applies to them.

We've written it to be very straightforward and clear and easy to understand so people can really navigate that process for their own individual needs.

But our intention, wherever possible, is to use data first.

-Okay.

And 2027 is when people can self-attest.

But then 2028 is when documentation is required.

What will that entail?

-So we're still planning for exactly what that looks like.

We have just over a year before those changes go into effect.

What that really means is, instead of allowing that attestation form first, we will have to collect documentation about an exclusion or about a qualifying activity.

We are awaiting federal guidance on exactly what documentation will be required for specific activities, but know that our intention is to be as clear and straightforward as we can to lower what we're asking of Nevadans, of their providers, of their employers to make that process as straightforward as we can.

-And Nevada did have some choice in how this was implemented.

Can you explain in what ways?

What choices did Nevada make as far as how this will be implemented?

-So, firstly, states have the option to determine how long does someone have to meet work requirements to still be eligible.

States could pick between one month and three consecutive months of eligibility.

Nevada selected one.

That's because it's really aligning with our economic landscape.

We recognize there is a lot of seasonal work in our state, a lot of shift work that can be complicated to represent on paper, and so we wanted to make that as straightforward as possible.

We also have choice in how exactly we define our medically frail exclusion, which we've worked with our provider community and community partners to define in a way that best aligns with Nevada's needs and goals.

And we also had a choice in terms of how we evaluate our renewals.

So the other change that's coming as a result of HR 1 is that people in our adult expansion population, so about 260,000 Nevadans, will move from an annual cycle of how frequently they renew their coverage to every six months.

States had a choice to reset everyone's renewal date on January 1st or to keep their currently scheduled renewal date and to move to that six-month cadence afterwards, which is the option that Nevada picked.

Our goal is to minimize disruptions to what people are already planning in their process.

What this means is people's renewal dates in which they have to potentially meet work requirements will fall throughout 2027, not all on January 1st.

That allows us time to learn quickly, to make any necessary adjustments to our public communications campaign, and to make sure that people are already planning for their renewal dates are able to go through the process and have a very clear next renewal coming up in six months after that.

-And I have one more question.

What is the expected impact on rural Nevadans?

-Absolutely.

Our rural expansion population is much smaller.

We're working to put data on our website that shows a breakdown by county of people that we think may need to actually provide information about work requirements in their renewal in 2027.

I will say Nevada has also selected another state choice that we made was to select to opt into what's called short-term hardship exceptions.

These are four very specific categories in federal law that states had the option to choose, and Nevada did choose to opt in to implementing those.

And we believe it's the right choice, particularly for our rural population.

Those exclusions include having to travel a long distance for care or having a recent hospitalization, living in a county with high unemployment rates, which in Nevada will apply to Mineral County, and we're continuing to evaluate if it applies to others.

And so we're doing everything we can to recognize that our rural communities already do face many barriers to accessing healthcare.

We want to make sure we're supportive with them and through that process.

So we're working very closely with our rural hospital association, the Nevada Association of Counties, and others to ensure that all of our rural communities are well prepared when these changes go into effect.

-The Nevada Medicaid website is available in a number of languages, including Spanish.

Just use the language drop-down menu at the top of the page.

Nevada Medicaid says it also offers free language assistance.