Nevada Set to Become Second State with Public Option Health Plan
The public option health plan would require a bidding process and the state would prioritize applicants whose networks align with Medicaid managed care networks, among other factors.
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- The state of Nevada could become the second state to embrace a public option health plan, if the governor signs SB420.
“Section 10 requires the Public Option to be available through the Exchange and for direct purchase and authorizes the Director to make the Public Option available to small employers in this State or their employees,” the SB420 bill summarized.
“Section 10 requires the Public Option to meet the requirements established by federal and state law for individual health insurance or health insurance for small employers where applicable. Section 10 also establishes requirements governing the levels of coverage provided by the Public Option and the premiums for the Public Option.”
The law aims to lower healthcare spending in Nevada by using the state’s purchasing power, opening up access to care particularly for small business employees, marginalized populations, and rural residents.
The public option plan would be available through the state health insurance marketplace as a individual marketplace health plan. As such, the health man would have to be a qualified health plan, offering the essential benefits mandated in the Affordable Care Act.
Payers would have to offer both a silver-level and a gold-level public option health plan.
Before the state can make any changes to the public option’s premium-related stipulations, the public option health plan would have to maintain an average premium that is 15 percent or more below the average reference premium. The public option health plan’s premium would have to be at least five percent below the reference premium for a given area.
Additionally, the premiums for the public option health plan would have to be synced with the Medicare Economic Index. Any increase in the public option health plan’s premiums cannot exceed the increase in the Medicare Economic Index.
As with other state-run healthcare programs such as Medicaid, the director of the ____ will conduct a bidding process for the management of the public option health plans, the bidding process for which would run concurrently with Nevada’s Medicaid managed care bidding process.
The state would prioritize applicants that meet five criteria. Provider networks between the public option health plan and Medicaid managed care program should be aligned and enrollees should have access to a broad range of care delivery sites from critical access hospitals to federally-qualified health centers.
Successful applicants might also have a strategy around provider workforce expansion, which is particularly crucial as the country emerges from the worst of the pandemic with an exhausted healthcare workforce. The state highlighted workforce strain in rural areas, mental and behavioral healthcare, and substance abuse care.
The payment model should boost the value of the plan for the patient—such as value-based care models—and the selected applications would likely reflect a focus on decreasing care disparities.
Additionally, the public option health plan would have to comply with certain regulations regarding reimbursement. For example, payers must meet or exceed Medicare rates in their public option reimbursement, as must federally qualified health centers and rural health clinics.
Public option health plans’ rates for community behavioral health clinics would have to match or exceed Nevada’s Medicaid rates of reimbursement.
The law will also expand the state’s Medicaid program, particularly for pregnant women.
The bill passed in the Assembly on May 30, 2021 with 26 proponent for the bill, 15 against, and one excused, Nevada’s legislative site showed. Six days before passing in the Assembly, the bill had received 12 favorable votes and nine opposing votes in the state Senate.
The bill has been enrolled and delivered to the governor, Steve Sisolak, as of June 2, 2021.
Sisolak has already agreed to sign the bill once it gets to his desk, according to local news outlets.
The state was exploring a public option in January 2021 shortly after President Joe Biden took office.
The new presidency stirred more interest in public option health plans, since the model was a significant element of President Biden’s campaign platform. Prior to the change in national leadership, Colorado was the only state to have a public option, which the state paused in 2020 due to the strain of the coronavirus pandemic.
