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Nevada Enacts Public Option

Nevada Gov. Steve Sisolak (D) this month signed legislation establishing a statewide public option insurance program.

Nevada is the second state to pursue a public option health coverage plan, after Washington implemented a public option in 2019. Nevada legislators began pursuing public option legislation in 2017 in an effort to expand coverage to the uninsured population, lower the cost of care, and reduce disparities.

The new law requires the state Department of Health and Human Services (DHHS), Division of Insurance (DOI), and Silver State Health Insurance Exchange to create a public option plan by 2026.

Plan Structure

The public option will be sold through Nevada’s health insurance exchange. Structural components of the public option plan include that it must:

  • meet criteria for classification as a qualified health plan, including offering essential benefits and being available directly to individuals and potentially small employers and employees;
  • provide coverage consistent with the actuarial value of one silver plan and one gold plan (existing plans on the marketplace);
  • be 5 percent lower in premiums than the average plan on the marketplace;
  • not increase in any year by a percentage greater than the increase in the Medicare Economic Index for that year; and
  • use a statewide competitive bidding process.


The state will require all managed care organizations contracted with Medicaid to submit a proposal. Further, the legislation indicates the state should prioritize health carrier applicants that demonstrate:

  • alignment in providers between the public option and Medicaid managed care;
  • inclusion for critical access hospitals, rural health clinics, behavioral health clinics, and federally qualified health centers;
  • strengthening of the state’s health care workforce;
  • payment models for providers that increase value for patients enrolled in the public option; and
  • contracting with health care providers in a manner that decreases disparities with regard to care access and health outcomes and supports culturally competent care.


The law requires DHHS, DOI, and the Silver State Health Insurance Exchange to apply for federal funding to develop the public option. The legislation mentions Section 1115 waivers, grant programs, and Section 1332 innovation waivers that can assist the state in funding plans.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Abigail Painchaud is a policy associate at America's Essential Hospitals.

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