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Medicaid, education numbers most notable in Gov. Sisolak’s proposed 2021-2023 executive budget

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Nevada Medicaid enrollment grew 18.7% more than expected, and now the bill is coming due.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


CARSON CITY, Nev. (KLAS) — The COVID-19 pandemic devastated Nevada’s economy which relies so heavily on tourism. Gov. Steve Sisolak’s 2021-2023 proposal reveals the financial challenges the state continues to face. Medicaid and education numbers were of the most notable in his plan.

When the state legislature first approved budget cuts, it was for a devastating 12%. That will not be the case, however, due to higher December revenue projections than predicted.

“My Executive Budget for 2021-2023 recognizes the emergency we are
experiencing as a result of the COVID-19 pandemic while also setting forth a clear plan to revitalize, innovate, and grow Nevada’s economy,” Sisolak said in a news release. “I am committed to remaining flexible and working closely with the legislature in this unprecedented and evolving fiscal situation.”

Full 2021-23 executive budget highlightsDownload

Moving into Medicaid, the proposal preview shows that during the current biennium, 2019-2021, the number of enrollees increased by 18.7% more than projected. An additional increase of 2.2% is projected for 2021-2023. These numbers are due in part to job losses.

The budget predicts by the end of the upcoming biennium, one in four Nevadans will be enrolled in Medicaid.

Education is also highlighted, with $331 million in supplemental appropriations designated to K-12. In the current biennium, K-12 and Nevada System of Higher Education (NSHE) state expenditures total $7 billion. Federal aid is expected to be a large part of funding for education.

A state official also noted no school will receive less than they did coming into this budget, which includes revenue from marijuana excise taxes.

Another big item to note is that state employee furloughs that went into effect on January 1, 2021 will not continue in fiscal year 2022-23.

Sisolak says his priorities are still recovering from the ongoing crisis, creating jobs, educating children, promoting justice and equality and protecting citizens’ health.

The proposal lists general fund expenditures $8,688,624,000, a 2% reduction from 2019-2020.

“Ultimately, State revenues, while still severely impacted by the economic crisis, never dropped as low as our worst expectations and this budget reflects that inconsistent, if not positive, ending point,” the news release says.

Sisolak will discuss his proposal during the State of the State address, slated to air at 6 p.m. on Tuesday, Jan. 19. Channel 8 will carry coverage of the speech and it will also be livestreamed on as well as the governor’s Facebook page.



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Nevada lawmakers told Medicaid will require nearly $12 billion over 2 years

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Medicaid now consumes more than 33% of the Nevada budget, and will spend $2B next year than the year before.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Lawmakers were told Thursday that the total Medicaid budget will consume $11.87 billion over the coming two-year budget cycle, more than a third of the total state budget for the coming two years.

That is an increase of $2.3 billion over the current budget, largely the result of the economic collapse caused by the pandemic.

Medicaid Administrator Suzanne Bierman told members of the Senate Finance and Assembly Ways and Means committees the reason is that the number of people receiving Medicaid coverage increased 128,139 since February 2020. By the end of the coming biennium, officials predict Medicaid will be serving 788,000 Nevadans — more than a quarter of the state population.

The federal government is currently covering 68 percent of that amount through the enhanced federal contribution that historically pays most of Medicaid for the states. Bierman said projections are that the percentage will decrease to 63 or 64 percent in the coming two years.

Officials are hoping the enhanced match percent will be extended but that decision hasn’t yet been made.

The total budget proposed by Gov. Steve Sisolak is $31.4 billion for the coming two years. While Medicaid is the majority of HHS spending, the department’s total budget is fully half the entire state budget at just over $15 billion when its other divisions are added in.

The proposed Medicaid budget does restore the 6 percent Medicaid provider rate reduction enacted by the special legislative session last summer. But Bierman said clearing that reduction through the Centers for Medicare and Medicaid Services takes time and it has not yet been authorized.

She said, however, her division is in contact with hospitals and other providers, advising them that, if and when the reductions are approved, the payments to those providers will be reduced retroactively back to August. Providers, she said, are still getting paid at the pre-reduction rates.

Several lawmakers questioned some of the reductions in other parts of the department.

There will be reductions in other divisions including Child and Family Services, Behavioral Health, Aging and Disability Services and Welfare that officials concede could impact clients in a long list of programs to achieve the necessary budget reductions and extend some waiting lists for different services. Dozens of positions will remain vacant in fiscal 2022 but the proposed budget says most will be restored and filled in 2023 as the state continues to recover.

HHS provides all those social, mental health and health services relied upon by the poor, mentally and physically disabled, the medically frail, children and the elderly including those in all categories in long-term care facilities.

In most cases, department officials say there won’t be a reduction in services in most cases but it may take longer for new clients to get services.

Lawmakers expressed concerns about holding some professional positions vacant in the northern and southern Nevada Mental Health facilities but division officials said they are having extreme difficulties filling those posts because private facilities pay significantly more for doctors, nurses, mental health professionals and other medical and psychiatric professionals.

The legislative briefings continue Friday with overviews of the K-12 and the Nevada System of Higher Education budgets along with the military department budget.



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Amazon surpasses Walmart for most Nevada employees and dependents on Medicaid

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7,892 Amazon employees are on Nevada Medicaid now, up from 4,040 last year.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Amazon has surpassed Walmart to become the employer with the most employees and dependents on Medicaid in Nevada, according to a new report from the state. 

The number of Nevada Amazon employees and dependents on Medicaid nearly doubled year over year, increasing from 4,040 to 7,892, despite statements on the company’s website that they offer medical, prescription drug, dental, and vision coverage to all of their employees, regardless of their level or position. Amazon reports having more than 10,500 full and part time jobs in the state.

The massive jump in Amazon employees and dependents covered by Medicaid came alongside a significant jump for Integrity Staffing Solutions, a job placement company that has two of its three listed Nevada offices located at Amazon fulfillment centers.

Integrity Staffing Solutions was the fifth-largest Nevada employer of Medicaid-covered employees and dependents in the 2020 fiscal year, increasing from less than 500 in the previous year to 1,746.

Walmart, the leading employer of Nevada Medicaid recipients in the last three fiscal years, fell behind Amazon, but its number of Medicaid-covered employees and dependents also continued to rise, increasing about 11 percent from the previous year to 7,725 in the last fiscal year.

Nevada Medicaid Recipients Employed by Employers with 50 or More Employees

Of the nearly 8,000 Nevada Walmart employees and dependents on Medicaid, 3,429 were company employees. The company reports having 14,548 employees in the state. Amazon would not indicate how many people it employs in the state.

Quentin Savwoir, the political director of Make It Work Nevada, a progressive non-profit and advocacy group, sees a problem with these increasing numbers. 

“If these corporations like Walmart, like an Amazon, invested in things like paying families quality, affordable childcare, or even just paying their employees equal pay, that would go a long way to making the lives of the women and families we work alongside a little bit better,” said Savwoir. “They wouldn’t have the need to rely on the social safety net.”

When asked for comment, Walmart’s communications department offered information about the pay and health care coverage provided to employees, including that the average total compensation and benefits for its hourly employees, both full- and part-time, is more than $18 an hour as of last January — and that eligible full- and part-time employees can receive medical coverage beginning at a cost of $30.50 per biweekly pay period. It also stated that the company’s goal is “moving people beyond entry-level jobs.”

An Amazon spokesperson said that the figures in the report are misleading because they include part-time workers and people who were only employed by Amazon for a short time, including seasonal employees.

We have hundreds of full-time roles available, however, some prefer part-time for the flexibility or other personal reasons,” an Amazon spokesperson said.

In Nevada, households with annual incomes of up to 138 percent of the federal poverty level — $16,753 per year for an individual or $34,638 per year for a family of four — may qualify for Medicaid. A single adult with three children would have to earn almost $17 per hour while working 40 hours per week to no longer be eligible for Medicaid.

That means that even full-time employees working for companies like Amazon and Walmart could qualify. Amazon pays its employees a minimum wage of $15 per hour, and Walmart employees in Nevada earn an average wage of $14.84 per hour.

The report from the Department of Health and Human Services’ Office of Analytics, which was mandated by a bill the Legislature passed in 2017, comes on the heels of a nationwide report released last November by the Government Accountability Office (GAO) that showed some similar trends.

The GAO report found that across the 11 states studied, Walmart was consistently one of the top employers of Medicaid and SNAP recipients. The report also showed that Amazon was among the top employers of workers on Medicaid. 

Sen. Bernie Sanders of Vermont, who commissioned the GAO report, called the findings “morally obscene.”

“U.S. taxpayers should not be forced to subsidize some of the largest and most profitable corporations in America,” Sanders said in a press release.

The growth in Medicaid recipients from employers with 50 or more employees resulted in an increased cost to Nevada Medicaid of $2.8 million from the 2019 to 2020 fiscal year.

That increase was much less than the combined increase for Amazon and Walmart employees — which in 2020 was nearly $12 million more than the previous year. However, that was offset by the decrease in the number of employees and dependents covered by Nevada Medicaid at other companies, including Clark County School District, Smith’s Food and Drug and Wynn Resorts.

During the 2020 fiscal year, Amazon and Walmart employees and dependents’ cost to Nevada Medicaid was more than $43 million. In that same period, the cost to Nevada Medicaid from companies with 50 or more employees was approximately $737 million.
As of November, more than 761,000 Nevadans were enrolled in Medicaid, which was 120,000 more than the 2019 Legislature had predicted. To account for that growth, Nevada will spend an additional $153.5 million on Medicaid in fiscal year 2022, according to the latest state budget proposal.


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