If you want to know where an administration's priorities are, look at its budget.

Under Gov. Joe Lombardo’s proposal, the most significant portion of funding, nearly 44 percent of the state budget, is allocated to the Department of Health and Human Services. Almost 29 percent of the budget is dedicated to Medicaid, a joint federal and state program that pays medical expenses for people with low incomes and now covers nearly one-third of Nevada’s population.

Medicaid has seen explosive growth since Nevada lawmakers opted into Medicaid expansion under Obamacare in 2012. More than 630,000 Nevadans have gained coverage since 2012, and the program now covers more than 930,000 people. 

Almost 70 percent of the state’s Medicaid budget is supported by federal funds, and in his proposed budget, Lombardo laid out plans for Medicaid reimbursement rate increases for physicians, dentists and nursing homes, as well as services to people with disabilities and certified behavioral health centers. 

Reimbursement rates are the rates providers are paid for services. Private insurance companies typically reimburse providers at higher rates than Medicaid, so providers often turn away patients who are on Medicaid, making it more difficult for them to find care.

Lombardo’s Chief of Staff Ben Kieckhefer said during a press briefing in early May that Medicaid rates are too low, presenting challenges to recipients and health care providers.

“[Existing Medicaid reimbursement rates] provide significant challenges for Medicaid enrollees to access care, and makes it incredibly difficult for physicians, hospitals, care providers to provide service to Nevada’s lowest-income families,” Kieckhefer told reporters. “So we're committed to continuing to increase those rates over time.”

Amid the state’s move to a statewide Medicaid managed care system, it is unknown how much the rate increases would make a difference for health care providers because the proposed provider rate increases are geared solely toward providers covered by Medicaid’s fee-for-service plan, which includes only about 25 percent of Medicaid recipients. The rate increases are only applicable to fee-for-service providers because the state cannot stipulate what private corporations can pay providers through the Medicaid managed care system.

But the budget isn’t the only Medicaid discussion taking place this session. Lawmakers are reviewing at least 33 measures on the topic, many of which are still awaiting review with less than 12 days left in the legislative session.

The following includes a summary of the most notable of those measures:

• Expenses for outpatient services — If passed, SB241 would require Nevada Medicaid pay the nonfederal share of expenditures for outpatient services and swing-bed services that allow a patient to transition from acute care to skilled nursing without leaving a hospital. The changes would apply to critical access hospitals (a Centers for Medicare and Medicaid Services designation given to small rural hospitals with fewer than 25 beds) and allow Nevada Medicaid to reimburse the hospital for those services at a rate equal to the actual cost of providing the services or the amount charged, whichever is less. The measure passed out of its first committee in April and received a hearing in the Senate Finance Committee on May 16.
• Medicaid services for incarcerated youth — AB389 proposes having Medicaid pay for certain services for incarcerated youth up to 90 days before their release. The bill received an exemption from legislative deadlines and received a hearing in the Assembly Ways and Means Committee on May 18.
• Extension of postpartum care for 12 months — Some pregnant people only qualify for Medicaid because of their pregnancy. But, after birth, though the child is covered by Medicaid for up to a year, the pregnant person is not. SB232, sponsored by Senate Majority Leader Nicole Cannizzaro (D-Las Vegas), is looking to change that. Under the bill, Nevada Medicaid would be required to provide coverage to Medicaid recipients for postpartum care for up to 12 months following the end of a pregnancy. The bill passed out of its first committee but was declared exempt from legislative deadlines and received a hearing in the Senate Finance Committee on May 11. 
• Behavioral health services and collaborative care — As proposed, AB138 would require the state to help cover behavioral health services and allow primary care doctors to work with other behavioral health care providers, such as psychiatrists. The bill passed out of its first committee but was declared exempt and awaits review in a budget committee.
• School-based health centers — AB237 aims to improve access to health care for school-aged children who are Medicaid recipients by facilitating the sharing of data between school-based health centers and qualified providers, requiring Medicaid managed care programs to negotiate with school-based health centers to provide health care services and raising certain reimbursement rates under Medicaid. The bill passed out of its first committee and awaits review in a budget committee.
• Art therapy — Sponsored by Assemblywoman Sarah Peters (D-Reno), AB338 would require Nevada Medicaid to cover art therapy. The measure also gives the state’s arts council the ability to provide financial support for art therapy programs. The bill passed out of its first committee but awaits a hearing in a finance committee.
• HOPE Act — Sponsored by Sen. Fabian Doñate (D-Las Vegas), SB419, also referred to as the HOPE Act, focuses on providing state-funded health care coverage to pregnant people and children under 17 who don’t qualify for Medicaid because of their immigration status. The bill awaits a hearing in a finance committee.
• Prohibiting step therapy — Step therapy is a process requiring patients to try and fail on one or more medications chosen by their insurer before they can access a specific drug or treatment recommended by their health care provider. SB167, sponsored by Sen. Marilyn Dondero Loop (D-Las Vegas), would prohibit private insurers, Medicaid and other insurance plans from imposing step therapy protocols for Food and Drug Administration-approved drugs or drugs used to treat psychiatric conditions. The bill received an exemption from legislative deadlines and passed out of the Senate with a unanimous vote May 15 and awaits review in the Assembly.
• Coverage for midwives — Sponsored by Assemblywoman Daniele Monroe-Moreno (D-North Las Vegas), AB386 would establish a licensing process for midwives and require Medicaid to cover the services of a licensed certified professional midwife. The measure received an exemption from legislative deadlines, received a hearing on Tuesday and awaits committee passage.
• Funding children’s mental health — AB445, sponsored by Assemblywoman Sabra Newby (D-Las Vegas), would create a new account to fund children’s mental health and allow donors who contribute to that fund to receive a tax abatement. The money would be used to increase Medicaid provider rates for children’s mental health. The bill awaits review in the Assembly Ways and Means Committee.
• Boosting Medicaid rates — SB435, would build upon an existing framework that grants private hospitals the ability to vote for a state-assessed “provider tax” of no more than 6 percent. Revenue from the tax would be earmarked as supplemental Medicaid payments as part of a federal dollar-matching program, thereby bringing in more federal dollars. The bill passed unanimously out of its first committee and has received an exemption from legislative deadlines. The measure received a hearing in the Senate Finance Committee on May 17 and awaits committee passage.