On February 19, 2026, the Nevada Health Authority (“NHA”) waived the requirement that healthcare providers enrolled in Nevada Medicaid (“Medicaid”), contracted with a Nevada Medicaid Managed Care Organization (“MCO”), or contracted with the Nevada Public Employees’ Benefits Program (“PEBP,” along with “Medicaid” and the “MCOs” the “Government Payors”) must contract with at least one health plan created under Nevada’s public option (the “Public Option”) as a condition of participation in the Medicaid program. NRS 422.2372(8) (requiring Medicaid administrator to “exclude from participation in Medicaid any provider of health care that fails to comply with the requirements of NRS 695K.230). The NHA’s February 19, 2026 waiver (the “Waiver”) retroactively applies beginning January 1, 2026, and extends through December 31, 2026. During this period, failing to participate in a Public Option plan will not require automatic exclusion from Medicaid.
Background
In 2021, Nevada passed legislation creating a Public Option to offer at least two health plans administered by MCOs contracted by the state to administer its Medicaid program. This law was enacted with a five-year phase in process. The laws creating and governing the Public Option within NRS Chapter 695K took effect on January 1, 2026. The Public Option plans, referred to as “Battle Born State Plans,” are plans offered on Nevada’s Affordable Care Act health insurance exchange at the gold and silver plan rating levels. NRS 695K.200(2), (3), and (6). By law, each plan’s pricing was set with a target at least 5% lower than the reference premium for the area where the plan is offered, and annual increases to the plan’s premiums are capped. NRS 695K.200(4).
NRS 695K.230(1) imposes certain duties on Nevada’s healthcare providers, including both licensed providers and facilities such as hospitals, surgery centers, and skilled nursing facilities. See NRS 695K.080; NRS 695G.070. Providers enrolled with Governmental Payors, or who provide services paid by workers compensation or occupational disease insurers (“Occupational Insurers”), are required to enroll in at least one Public Option plan and accept new patients enrolled in Public Option plans just as they would any other new patient, regardless of payor identity. NRS 695K.230(1).
The 2021 adoption of the Public Option also saw an amendment to Nevada’s Medicaid laws, specifically NRS 422.2372. Although enacted in 2021, this amendment took effect on January 1, 2026, and required the Medicaid administrator to exclude from the Medicaid program (including through MCO administration), all healthcare providers who fail to enroll with at least one Public Option plan. NRS 422.2372(8). Thus, whether through conscious choice, ignorance, or difficulties in contracting or obtaining an appointment to a Public Option plan’s provider panel, healthcare providers may find themselves excluded from Medicaid. To address concerns of provider disenrollment or exclusion, NRS 695K.230(2) allows the Medicaid Director and Executive Director of PEBP to waive the requirements of 695K.230(1) to ensure that beneficiaries of such programs “have sufficient access to covered services.”
The Waiver
The Waiver is issued under the authority granted by NRS 695K.230(2) and granted “to ensure sufficient access to covered services during the first year of the new [Public Option] program,” as the NHA’s Director, Stacie Seeks, “determined it is necessary to waive this requirement.” No further information regarding the reasons for this necessity are explained within this waiver. During this waiver period, the NHA “encourages eligible providers to work with the state’s three Battle Born State Plan carriers to ensure compliance with subsection 1 of NRS 695K.230 no later than January 1, 2027.”
Considerations
Importantly, the Waiver’s text limits its application only to Governmental Payors. This waiver is silent to the Occupational Insurers, and it currently is not clear whether failure to participate in a Public Option plan requires an Occupational Insurers to terminate their payor agreements with providers. Similarly, providers enrolled in PEBP are advised to consult their payor agreements to determine whether non-participation in a Public Option plan may result in PEBP’s termination of that agreement.
Subscribe to get our Insights delivered to your inbox.
This publication is designed to provide general information on pertinent legal topics. The statements made are provided for educational purposes only. They do not constitute legal or financial advice nor do they necessarily reflect the views of Holland & Hart LLP or any of its attorneys other than the author(s). This publication is not intended to create an attorney-client relationship between you and Holland & Hart LLP. Substantive changes in the law subsequent to the date of this publication might affect the analysis or commentary. Similarly, the analysis may differ depending on the jurisdiction or circumstances. If you have specific questions as to the application of the law to your activities, you should seek the advice of your legal counsel.