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New Community Work Requirements for Certain Individuals
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Sep 30, 2026
Summary
Starting January 1, 2027, Nevada Medicaid is implementing new community work requirements for adults ages 19-64, requiring 80 hours of work, school, or volunteering per month to maintain eligibility. Additionally, redetermination cycles are changing from annual to semi-annual for affected members. Billing teams must prepare to verify member eligibility and redetermination dates, as non-compliance with work requirements will affect coverage.
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What to do
by Dec 31, 2026 · 4 steps
01Billing team must update eligibility verification workflows to check member redetermination dates in the Nevada Medicaid Provider Web Portal (PWP) Eligibility Information Verification section before processing claims.
02Front desk staff must prompt all Nevada Medicaid members ages 19-64 to verify and update contact information with the State through methods outlined on the HR1 section of Nevada Medicaid website to ensure they receive redetermination notices.
03Establish a process to flag claims for members whose redetermination dates fall on or after January 1, 2027 for enhanced eligibility verification, as these members must meet new work requirements at each renewal.
04Distribute Nevada Medicaid Partner Resources Toolkit (flyers, FAQs) in patient waiting areas and during patient intake.
If missed: Failure to verify eligibility and work requirement compliance may result in claim denials for members who do not meet the 80-hour monthly requirement or miss redetermination deadlines.
Original notice
New Community Work Requirements for Certain Individuals
medicaid.nv.gov · Always check the source before changing claims.