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New Medicaid work requirements effective next year

As part of the One Big Beautiful Bill Act, changes are coming to Medicaid and many of the residents who rely on this program for their health insurance will be impacted by the implementation of new “community engagement” requirements.

“As required by law, on June 1, 2026, the Centers for Medicaid Services (CMS) issued an interim final rule implementing a new statutory requirement for certain adults in Medicaid to meet an 80-hours-per-month work requirement (sometimes referred to as Medicaid community engagement) as a condition of eligibility,” the CMS announced earlier this year. “States must generally implement this requirement no later than January 1, 2027.”

Nevada will be among the states that will be making the shift to work requirements as the year 2027 starts. Under the terms of the One Big Beautiful Bill Act, certain people receiving Medicaid will be required to complete at least 80 hours of “community engagement” per month. These hours can take the form of traditional employment, self-employment, job training, volunteering or school.

According to the CMS, the new requirements apply to adults ages 19-64, with the exception of: those who are pregnant or in a postpartum period; the disabled or medically frail; parents and caregivers of children under 14 years of age or of people with disabilities; American Indians and Alaska natives; and certain other individuals.

“States may also elect to offer short-term hardship exceptions for individuals subject to work requirements under specific circumstances,” the CMS explains. “For example, those receiving inpatient or certain other medical services, individuals who need (or whose dependent needs) to travel outside their community for certain medical care not available in their home community, those in a county with an unemployment rate at or above 8% or 1.5 times the national average and those who reside in a county where certain national emergencies or disasters exist.”

In an effort to ensure those in the Silver State understand how these changes will affect them, SilverSummit Healthplan recently launched an education and outreach initiative aimed at helping residents navigate the new requirements.

“SilverSummit Healthplan is building a statewide network across the nonprofit, workforce, education and community-based sectors to help eligible members comply with the Medicaid eligibility requirements,” a news release from the company announced. “Through a dedicated online resource page, members will be able to search for local partner organizations offering volunteer opportunities, workforce services, educational programs and other resources.”

In addition to the new work requirements, the upcoming changes include a requirement to renew every six months, rather than annually.

“The state will verify eligibility when members apply for coverage and every six months after that,” SilverSummit detailed. “SilverSummit Healthplan is encouraging members to keep their contact information current with Nevada Medicaid to ensure they receive important information about their coverage and renewals.”

On SilverSummit’s website, residents will find an overview of the new work requirements and biannual renewals, along with a frequently-asked-question section addressing various relevant topics. These include information on how members will know if they are affected by the work requirements, how to report work or community engagement activities, what happens if a renewal is not completed and more. The section also contains a link to the company’s community partners page, where residents can find a list of organizations that can help in fulfilling work hour requirements.

“As these changes approach, our priority is making sure Nevada Medicaid members have the information, support and resources they need,” SilverSummit Interim Plan President and CEO Andre Cisne stated. “SilverSummit Healthplan is committed to meeting members where they are through education, outreach and community partnerships to help them understand and prepare for what’s ahead and help eligible members comply with the requirements that apply to them.”

For more information visit SilverSummit’s website at tinyurl.com/33hvkb8w or the CMS website at tinyurl.com/y8vdt223

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