Nevada joins with federal proposals to roll in non-group market

There are efforts at the federal level and now the state level to integrate the problem step child of non-group medical insurance into other forms of insurance to offering greater access at lower cost. The federal proposals would allow individuals not covered in the employer group or other government insurance programs to purchase employer group coverage via the District of Columbia health benefit exchange’s Small Business Health Options (SHOP) and the Federal Employees Health Benefits Program. Pending legislation recently sent to the desk of Nevada Gov. Brian Sandoval takes a different tack. It would authorize the state to seek federal waivers in order to allow Nevadans to purchase Medicaid managed care plan coverage though its health benefit exchange as Vox reported this week. Implicit in both of these moves is a lack of confidence that adequate spread of risk can be achieved in the non-group insurance segment, particularly in smaller states like Nevada.

Noticing the close household income eligibility nexus between its subsidized health benefit exchange and Medicaid populations, Nevada provides Medicaid managed care plans incentive to offer qualified health plans (QHPs) on its exchange to ensure adequate availability of QHPs as Vox’s Sarah Kliff reported in May. With Medicaid enrollments strongly outpacing commercial QHP enrollments in state health benefit exchanges, a number of factors began aligning in 2015 to set the stage for policymakers to allow Medicaid managed care plans to be offered on the exchanges alongside individual Qualified Health Plans (QHPs).

A major question is whether those who enroll in Nevada’s proposed “Medicaid for all” Nevada Care Plan will be able to find medical providers who will accept their plan given the historical shortfall between state Medicaid reimbursement levels and those of Medicare and commercial plans.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email or call 530-295-1473. 

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Frederick Pilot

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