Since October 1, some lawfully present immigrants no longer qualify for Medicaid.

A federal change under H.R. 1 ended Medicaid and CHIP eligibility for many people who are in the United States legally — including refugees and people granted asylum who don't yet have a green card, humanitarian parolees, survivors of trafficking, and people with Temporary Protected Status. Emergency Medicaid still covers emergency care and childbirth. People who remain eligible include US citizens, green-card holders who meet the five-year rule, Cuban and Haitian entrants, and COFA citizens of the Marshall Islands, Micronesia and Palau. If this may affect you or someone in your household, open any letter your state sends and ask about a community health center near you — they charge on a sliding scale regardless of immigration status. Read the full explainer →

New Medicaid work rules start in 92 days What you have to do →

All states Nevada

Nevada

Nevada Medicaid and the new work rules

Nevada Medicaid covers adults ages 19-64 with income up to 138% of the federal poverty level through the ACA expansion group (eligibility code "AM1 Expanded Parent & Caretakers"). is run by Nevada Health Authority (NVHA) — created July 1, 2025 by Senate Bill 494 (2025), consolidating the former Division of Health Care Financing and Policy (DHCFP, now branded "Nevada Medicaid"), Medicaid eligibility functions formerly in the Division of Welfare and Supportive Services (DWSS, now the Division of Social Services, DSS), and the Silver State Health Insurance Exchange (Nevada Health Link). Nevada expanded Medicaid on 2014-01-01, which is why the new federal work requirement reaches this state — and why what you do before January 1, 2027 matters.

Work rules start January 1, 2027 Medicaid expanded 800,000 enrolled 313,000 in the expansion group
Start here

From January 1, 2027, most adults have to show 80 hours a month

The requirement applies to adults aged 19 to 64 covered through Medicaid expansion — around 313,000 people in Nevada. It is not only about paid work: study, job training, volunteering and a mix of them all count , and earning at least $580 a month satisfies it on its own.

Nevada has not published a detailed verification plan as of October 2026. CMS's interim final rule framework directs states to first attempt to verify compliance through existing data sources (wage data, SNAP/TANF records, unemployment insurance records) before requiring enrollees to submit documents themselves; whether Nevada's eligibility system will do this automatically was not confirmed.

If your hours swing from month to month, say so. The rule is written per month, which is the wrong shape for farm and fishing work, construction, tourism and seasonal retail — a good month and a dead month average out to a living, but the dead month is the one that fails. Federal law has a provision for exactly this: a seasonal worker can satisfy the requirement using their average monthly income over the previous six months instead of hours worked in the month being checked. It is at 42 CFR 435.552(a)(7), and the law defines who counts as seasonal by pointing at the tax code rather than listing jobs, so do not decide for yourself that it misses you. If your work is seasonal or your hours are irregular, tell the state that when you report, and ask for the six-month average to be used.

2025-07-04 · already happened
H.R. 1 (P.L. 119-21) signed into federal law, creating the Medicaid community engagement requirement
2026-06-01 · already happened
CMS issues interim final rule (CMS-2454-IFC) implementing the work requirement
2028-01-01
Nevada moves from self-attestation to documentation-based verification, per secondary reporting

You do not have to prove anything if any of these describe you

Exemptions are meant to be applied by the state automatically from records it already holds, but records are imperfect. If one of these fits you and you still get asked to report hours, say so and ask them to check — don't assume the notice is right.

Parents or caretaker relatives of a child age 13 or younger, or of a person with a disability
Pregnant and postpartum people
People who are medically frail or have serious or complex medical needs
Veterans with a total disability rating
American Indians and Alaska Natives
People currently in treatment for a substance use disorder
People already meeting SNAP or TANF work requirements
People who were recently released from incarceration
Two things people get wrong

Before you assume this applies to you the way you think

If your hours go up and downNevada's economy is unusually concentrated in hospitality and gaming, where scheduled hours commonly swing week to week even for someone working steadily all year. The federal work requirement is normally checked month by month, which is a bad fit for that kind of job. CMS's interim final rule (91 Fed. Reg. 33353-33354, published June 3, 2026) includes a specific alternative for seasonal workers, as defined under 26 U.S.C. §45R(d)(5)(B): instead of showing 80 hours or $580 in a single month, a seasonal worker can qualify by showing that their average monthly income over the preceding six months meets or exceeds the federal minimum wage times 80 hours.
Income limits

What you can earn and still qualify

Monthly income, before tax, for the whole household. These are the state's own published figures, which is what its caseworkers actually apply. If you are close to a line, apply anyway — some income does not count, and only the agency can run the calculation for your situation.

Adults 19 to 64138%% of the poverty line

1 person
$1,800
2 people
$2,433
3 people
$3,065
4 people
$3,698
5 people
$4,330
6 people
$4,963
7 people
$5,595
8 people
$6,228

Parents and caretakers138%% of the poverty line

1 person
$1,800
2 people
$2,433
3 people
$3,065
4 people
$3,698
5 people
$4,330
6 people
$4,963
7 people
$5,595
8 people
$6,228

Pregnant190%% of the poverty line

1 person
$2,478
2 people
$3,349

Source: Nevada Division of Welfare and Supportive Services (now Division of Social Services), Medicaid Eligibility and Payments Manual, Appendix A — MAGI Income Chart, effective 4/1/2025 (MTL 06/25, issued July 2025). A note on precision: The live dss. We publish the state figure.

January 1, 2027

Two other changes land on the same day

Renewals get more frequent, and back-dated coverage gets shorter.

Renewals every six months Because of H.R. 1, Nevada's expansion-group enrollees will need to renew their eligibility twice a year instead of once, starting with the work requirement's effective date.
Back-dated coverage is changing on January 1 Nevada's ACA expansion group gets one month of retroactive coverage; everyone else gets two months. Both are down from three months under prior law. If you have unpaid medical bills, applying sooner covers more of them.

P.L. 119-21 §71112, amending 42 U.S.C. §1396a(a)(34). Applies to applications submitted on or after January 1, 2027.

Do this now

Update your address and phone number first. Everything about the new rules arrives by mail, and a stale address is the most common reason people lose coverage they are still entitled to. Then check whether an exemption applies to you.

Apply, renew or update details Access Nevada Access Nevada (accessnevada.nv.gov) is the online portal for applying, renewing, and checking the status of Nevada Medicaid, SNAP, and other DSS benefits. Talk to a person (702) 486-1646 DSS eligibility/Medicaid customer service — Southern Nevada (Las Vegas area) DSS eligibility/Medicaid customer service (775) 684-7200 Northern Nevada (Reno/Carson City area) Toll-free statewide line, intended for rural callers outside the Las Vegas and Reno local calling areas (800) 992-0900

About the phone numbers: Nevada reorganized its health and welfare agencies on July 1, 2025 (DHCFP and DWSS folded into the new Nevada Health Authority), so older brochures and some search results still show pre-reorganization DHCFP/DWSS branding and web addresses. Callers should expect a phone menu that routes between eligibility (DSS) and medical/provider billing (Nevada Medicaid) questions — picking the wrong option is a common complaint.

Deaf, hard of hearing or speech-impaired: 711 (Nevada Relay).

EnglishSpanish

Nevada Medicaid provides key notices and application materials in English and Spanish, and offers free interpreter services over the phone in other languages when you call to apply, renew, or ask about your case. If you need an interpreter, say so as soon as you reach a caseworker.

If a letter arrives

Most people who lose coverage lose it over paperwork, not eligibility

Nationally, most people who lose Medicaid lose it over paperwork rather than because they stopped qualifying. From January 1, 2027 that matters more, not less.

Nevada Health Authority (NVHA) — created July 1, 2025 by Senate Bill 494 (2025), consolidating the former Division of Health Care Financing and Policy (DHCFP, now branded "Nevada Medicaid"), Medicaid eligibility functions formerly in the Division of Welfare and Supportive Services (DWSS, now the Division of Social Services, DSS), and the Silver State Health Insurance Exchange (Nevada Health Link). · Notice of action

NOTICE OF ELIGIBILITY DETERMINATION

Case number: ███████
Date of this notice: 1January 12, 2027

Our records do not show that you met the community engagement requirement for the reporting period.

2If you believe this is incorrect, or if an exemption applies to you, contact us on or before February 11, 2027.

3Coverage for other members of your household is not affected by this notice.

1
The clock starts on this date. Not the day it reached you. Assume you have less time than it feels like.
2
"Our records do not show" is not the same as "you did not".The state is matching against databases that are often out of date. If you worked those hours, or an exemption fits you, say so — call (702) 486-1646.
3
Your children's coverage is separate. The work requirement does not apply to them. A notice about you does not end their coverage.
4
You can ask for a fair hearing. It's free, you don't need a lawyer, and asking can keep your coverage running while it's reviewed.
Know your state

What the federal data says about coverage here

Public federal data describes how each state runs its program. Almost all of it is written for policy analysts. Here is what those numbers mean if you are the person enrolled.

How care is delivered
Managed care

Coverage here runs through private health plans rather than the state paying providers directly. You pick a plan, and your plan decides your network.

Check your doctor is in the plan before you choose it.

Where you live in this state changes what coverage is worth. Outside the Las Vegas (Clark County) and Reno (Washoe County) metro areas and Carson City, Nevada is overwhelmingly rural or "frontier" (6 or fewer people per square mile). The Nevada Health Authority's Rural Health Transformation Program narrative cites an average distance of about 56 miles to the nearest hospital and about 109 miles to the nearest tertiary-care hospital for rural Nevada residents, and notes that every rural and frontier county in the state has at least a partial Health Professional Shortage Area designation. Nevada Health Authority, Rural Health Transformation Program narrative/application materials; corroborated by the Nevada Rural and Frontier Health Data Book (University of Nevada, Reno School of Medicine)

Common questions

Questions people ask about this

Do the new Medicaid work rules apply to me in Nevada?
They apply to adults aged 19 to 64 who are covered through Medicaid expansion — about 313,000 people in Nevada. Children, people over 65, and most people covered on grounds of disability or pregnancy are not in that group. There is also a long list of exemptions.
How many hours a month do I have to work?
80 hours a month. Work is not the only way to meet it — study, job training, volunteering and a combination of these count too, and earning at least $580 a month also satisfies it.
Who is exempt from the work requirement in Nevada?
Exemptions include: Parents or caretaker relatives of a child age 13 or younger, or of a person with a disability; Pregnant and postpartum people; People who are medically frail or have serious or complex medical needs; Veterans with a total disability rating; American Indians and Alaska Natives; People currently in treatment for a substance use disorder; People already meeting SNAP or TANF work requirements; People who were recently released from incarceration.
When do the Nevada work rules start?
January 1, 2027. Because of H.R. 1, Nevada's expansion-group enrollees will need to renew their eligibility twice a year instead of once, starting with the work requirement's effective date. Keeping your address and phone number current with the state is the single most important thing to do before then, because everything arrives by mail.
What is the income limit for Nevada Medicaid?
For adults 19 to 64, about $1,800 a month for one person and $6,228 for a household of 8.
How do I apply for Nevada Medicaid covers adults ages 19-64 with income up to 138% of the federal poverty level through the ACA expansion group (eligibility code "AM1 Expanded Parent & Caretakers").?
Online at Access Nevada, or by phone on (702) 486-1646. It is free and there is no open-enrollment window — you can apply at any time of year.
How often do I have to renew Nevada Medicaid?
Adults covered through Medicaid expansion move from a yearly renewal to one every six months starting with renewals due on or after January 1, 2027. Children, people over 65 and most people covered on grounds of disability stay on yearly renewals. Keep your address and phone number current so the renewal notice reaches you, and answer it before the date on the letter — most people who lose coverage lose it over paperwork.
Other states

Guides for neighboring states

The rules change completely at the state line. If you moved recently, or you're helping family somewhere else, start with their state rather than this one.

ArizonaThe new work rules CaliforniaThe new work rules IdahoThe new work rules OregonThe new work rules UtahThe new work rules

See all 50 states and Washington, D.C. on the map →

If you work in hospitality, gaming, or another job where your hours change from month to month, know this: starting January 1, 2027, Nevada Medicaid's expansion group must show 80 hours of work, school, or community engagement in a given month to stay covered, unless a federal rule lets you average your hours over the prior six months instead.

If your schedule was not steady every month this year, ask your caseworker specifically about the six-month averaging option for seasonal or fluctuating income before you lose coverage over a single slow month.

Updating your address takes two minutes and protects everything else. Do that first, then check the exemption list above.

Go to Access Nevada →