Lawmakers unveil plan to offer Medicaid regardless of citizenship status

Jannelle Calderon
Jannelle Calderon
Tabitha Mueller
Tabitha Mueller
Health CareLegislature

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State Sen. Fabian Doñate (D-Las Vegas) announced more details on Thursday about his plan to expand Medicaid coverage to all Nevadans regardless of citizenship status.

Doñate initially pitched the concept of expanding Medicaid to people who are undocumented last month during a press conference held by the Latino Legislative Caucus. But this week, Doñate outlined the goals of a far-reaching measure he called the “Nevada Health Opportunities, Planning, and Expansion (HOPE) Act.” He said it would “build equity,” reduce costs and improve the state’s health care infrastructure by expanding access to care and investing in technology and jobs. 

“Nevadans deserve a state that looks out for them, where you don't have to worry about leaving the state to receive the care that you need, or wonder how you'll pay for your medical bills because of the lack of health insurance coverage,” he said during the press conference. “No Nevadan gets left behind. No one is forgotten.”

A draft of the bill proposal, which has not been formally introduced, goes beyond expanding Medicaid coverage to undocumented people. It also would seek to establish a pathway for Nevadans to access their health records directly from their provider anywhere and at any time, and establish private-public partnerships to improve health care outcomes. It also proposes offering health care groups the ability to apply for tax incentives when they build facilities and hire doctors, among other expansions.

The proposal would also create the “Nevada Innovation Hub,” a state-run database to keep patients’ health information to prevent duplicated information between agencies. 

A 2017 report from the Kaiser Family Foundation indicates undocumented immigrants are at a high risk of being uninsured. Among people 65 and younger, about 45 percent of undocumented immigrants were uninsured, compared with 23 percent of lawfully present immigrants and 8 percent of citizens.

According to the National Conference of State Legislatures, California, Illinois, Massachusetts, New York, Oregon, Washington and the nation’s capital have expanded their Medicaid programs to provide insurance for all children, regardless of immigration status. But for undocumented adults, health care options may be limited to emergency services and charity or nonprofit care. 

Doñate said he and other proponents of the bill are in “preliminary discussions” with Republican Gov. Joe Lombardo and plan to continue those efforts as the bill is formally introduced. A spokesperson for the governor said in a statement that the office is monitoring “all bills as they work through the legislative process and engage when we feel necessary.”

“Collectively, we know that our state can do a little bit better when it comes to health care, which is why this bill is focused on economic development and closing the gaps that we have in access to care,” Doñate said. “We have to do a better job of taking care of one another, and those investments are worthy.”

Oscar Delgado, CEO of Community Health Alliance, speaks at the unveiling of a plan to expand Medicaid coverage regardless of citizenship status on Thursday, March 16, 2023 at the Legislature in Carson City. (David Calvert/The Nevada Independent)

Nevada Medicaid, a joint federal and state program, provides health insurance to more than 900,000 low-income individuals in the state. 

According to a 2019 Guinn Center report on uninsured populations in Nevada, an estimated 210,000 Nevada residents (about 7 percent of the state population) were “unauthorized immigrants,” or undocumented, in 2017. It’s estimated that between 94,500 and 109,000 of them do not have health insurance and would qualify for Medicaid, and Doñate said that figure “continues to increase.”

Doñate said he asked for affected agencies to submit fiscal notes estimating the bill’s cost.

“It’s incredibly difficult to find the true estimates of this population,” he said. 

Based on average costs per member, per month, Doñate said it would cost the state’s general fund approximately $78.5 million annually to cover the 94,500 individuals who qualify, but it is not “finite.” 

He said that the state already spends between $700 million and $800 million a year in uncompensated care. 

“We're paying for this, whether or not we admit it,” Doñate said. “This is a significantly more affordable and fiscally responsible investment.” 

Doctors and patients joined the senator at a press conference on Thursday to share their experiences with the health care system and support the bill, saying it would allow for more access to services and reduce stigma and hesitation around seeking care that can lead health problems to escalate and threaten a patient’s life.

“If our brothers and sisters hesitate to see primary care, their untreated conditions will land them, more likely than anything, in the emergency room,” said Oscar Delgado, CEO of Community Health Alliance, a network of clinics serving patients regardless of a person’s income or insurance status. “All because their immigration status made them think that they couldn't see a doctor. That's not right.” 


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