Dive Brief:

• Nevada intends to award new Medicaid managed care contracts to UnitedHealth, Centene, Elevance, Molina and nonprofit health plan CareSource, according to state documents released Wednesday.
• Centene added a few rural counties, UnitedHealth lost one populous county and CareSource entered Nevada for the first time. But if Nevada divvies out contracts as intended, it shouldn’t dramatically change the current makeup of Medicaid managed care in the state, according to an analyst.
• The new contracts begin Jan. 1, 2026.

Dive Insight:

Nevada sent out a request for Medicaid contract proposals in October that would expand its managed care program to cover almost everyone in the state. Currently, Nevada only offers managed care in Washoe and Clark counties, which are highly urban and include cities like Reno and Las Vegas.

However, the state newly budgeted to finance expanding managed care to all counties in the state, which is expected to add about 75,000 individuals to the coverage.

UnitedHealth, Elevance, Centene and Molina are incumbents in the state. UnitedHealth holds about 35% of Nevada’s managed care enrollment, while Elevance, Centene and Molina follow with 34%, 17% and 15% respectively, according to state data.

Nevada’s health department said in October that it anticipated awarding four contracts come this year. But in a notice of intent to award released Wednesday, the state said it plans to award contracts to five payers: Centene subsidiary SilverSummit Healthplan; nonprofit health plan CareSource; Molina Healthcare; Elevance subsidiary Community Care Health Plan of Nevada; and Health Plan of Nevada, a UnitedHealth subsidiary.

Centene and CareSource scored the highest, and received contracts for both Clark and Washoe counties along with Nevada’s rural areas. Elevance and Molina were also awarded contracts for Clark and Washoe counties.

UnitedHealth only received an award to serve Clark county. Previously, the insurer had contracts for both Clark and Washoe.

Nevada’s notice doesn’t actually award final contracts, but shows those managed care organizations’ proposals were selected for contract negotiations with the state.

“This result broadly holds serve in NV for the MCOs, with some very modest puts and takes as we expect some enrollment reshuffling as a result of the awards,” JP Morgan analyst John Stansel wrote in a Wednesday note.

Insurers that ink deals with states to administer managed care programs compete aggressively for the contracts, which can be lucrative. However, the current outlook for Medicaid funding is unclear, given the safety-net insurance program — which, along with its sister program for low-income children, currently covers roughly 80 million Americans — is on the chopping block for spending cuts as Republicans in Congress look for ways to pay for the president’s tax plan.

Conservatives on the Hill have yet to coalesce around a specific blueprint for cuts. But likely strategies include shrinking funding mechanisms that critics say allow states to sidestep their share of Medicaid spending or enacting work requirements for beneficiaries to qualify for Medicaid coverage.

Republicans are also debating rolling back federal funding for the Medicaid expansion population. Under the Affordable Care Act, states could expand Medicaid coverage to a greater share of their low-income population in return for the federal government assuming a greater share of their medical costs.

In Nevada, for example, the federal government pays 60% of costs for the traditional Medicaid population, and 90% for the expansion population, according to health policy firm KFF.

Top Republicans have characterized pending cuts as an effort to crack down on waste, fraud and abuse that won’t affect patients. However, if the federal government shrinks its Medicaid spending, states would have increase their own Medicaid spending to pay for the difference — or reduce benefits or kick people off the program.

In Nevada specifically, if the federal match rate for the state’s expansion population is stripped, more than 300,000 people could be booted from Medicaid and the state could lose about $670 million in revenue each year, according to health policy firm KFF.

Before Medicaid expansion, Nevada had one of the highest uninsured rates in the nation.