-Major changes to Medicaid are coming.

What the state wants recipients to know, plus... -Because it's a lot to caregive, right?

We care 24 hours; there's no clock.

It's not a clock-in job.

It's not a 9-to-5 job.

-A local caregiver gets national recognition for her work supporting aging veterans and the people who take care of them.

That's this week on Nevada Week.

♪♪ Support for Nevada Week is provided by Senator William H. Hernstadt and other supporters.

-Welcome to Nevada Week.

I'm Amber Renee Dixon.

Starting in 2027, some Nevadans on Medicaid will have to work, volunteer, or go to school to keep their coverage.

That's because of changes in HR 1, the Federal Tax and Spending Law, often called the One Big Beautiful Bill.

Nevada Medicaid now estimates 30- to 50,000 Nevadans could lose coverage in 2027.

States do have some say in how the new rules are carried out, and so we talked with Ann Jensen, Administrator of Nevada Medicaid, to find out what Nevadans need to know.

Our conversation began with what actually happens on January 1.

(Ann Jensen) January 1 is when the requirements begin; but, importantly, they begin for people that newly enroll in Medicaid on or after that day or people that initiate their Medicaid renewal.

So what that means is on January 1, there will be people that receive their Medicaid renewal packet in the mail 60 days in advance of their renewal date, which is March 31st would be the earliest group of people that are impacted by these changes.

In that renewal packet, people may see questions related to work requirements if Nevada Health Authority wasn't automatically able to accept, exempt, or comply them based on data that we already have.

So if we have information about whether someone's already meeting work requirements or if they don't apply to them, then we won't ask any further questions and that packet will look as it normally does.

But starting January 1st there may be an addition to that packet, which would be a screener for work requirements, which would help us collect information that we may not have already and determine whether someone is eligible to maintain their Medicaid coverage.

-So for any Nevadan on Medicaid right now, what should they do?

-Absolutely.

There's two important things that people can do right now to prepare for these changes: first is to make sure their contact information is as up to date as possible with the state so we know where to reach you if we have additional questions or need more information; secondly, we ask people to figure out when their redetermination date is in 2027.

That will help you prepare for when you need to meet these requirements.

If you have any questions on what the requirements are or whether they apply to you, we recommend you go to our website, which is nevadamedicaid.nv.gov.

The top of that webpage, we have a link to a really comprehensive resource on all things Medicaid eligibility changes, including an online kind of screening tool that gives you a non-binding way to provide some information, and it will tell you whether this may or may not apply to you, which is a really helpful planning resource.

We also have online, over the phone, and in-person resources available if you have further questions about your particular situation.

-Who has to meet the work requirements, and who does not?

Who is exempt automatically?

-There's a number of exemptions and exceptions that apply based on federal law and our state policy decisions.

At a high level, it's adults ages 19 to 64 that are not parents or caregivers of young children that otherwise have an ability to work or volunteer.

There's a number of different exclusions, and I won't be able to cover all of them in its comprehensiveness.

And so what's available on our website is a resource that lists every single one of those that will help people evaluate their individual situation.

Our intention is to be as clear and transparent as possible as we evaluate whether someone needs to meet these requirements.

-And simply because you said "caregivers," do you mean of only children, or can you be a caregiver for an elderly parent, for example?

-It's a great question.

There are exclusions.

Parents of children under the age of 14 are automatically excluded.

However, people that have caregiving responsibilities for other family members that relate to their activities of daily life are potentially eligible for what's called a hardship exception.

And so there's a process for people to provide a little bit more information on that and to attest to the fact that that describes their situation, and that would allow them to be excluded from work requirements in 2027.

-What are the work requirements?

What counts?

-Absolutely.

Work requirements is perhaps too narrow of a word to describe it, because there's a number of qualifying activities.

Those include working, of course; education programs such as a GED program or a college program; job training or apprenticeship programs also count as well, as does volunteering.

And so any combination of those activities has to total 80 hours in one month for someone to qualify for their Medicaid coverage to be renewed.

-How does someone keep track of that and report it accurately?

-Absolutely.

First and foremost, we try to use data that we already have.

So we have an ability to review wage data and other employment data to automatically comply someone with these requirements.

We think about 60% of Nevadans that will go through the work requirements process will be evaluated automatically with data, and we won't have to ask them for any more information.

If, for example, someone is qualifying based on a GED program or a volunteer program that we don't have data for, they have an opportunity in 2027 to complete what's called an attestation form.

That's an online or on-paper form that comes as part of the renewal process that guides people through each of our exclusions and kind of compliance activities and asks them to attest whether that applies to them.

We've written it to be very straightforward and clear and easy to understand so people can really navigate that process for their own individual needs.

But our intention, wherever possible, is to use data first.

-Okay.

And 2027 is when people can self-attest.

But then 2028 is when documentation is required.

What will that entail?

-So we're still planning for exactly what that looks like.

We have just over a year before those changes go into effect.

What that really means is, instead of allowing that attestation form first, we will have to collect documentation about an exclusion or about a qualifying activity.

We are awaiting federal guidance on exactly what documentation will be required for specific activities, but know that our intention is to be as clear and straightforward as we can to lower what we're asking of Nevadans, of their providers, of their employers to make that process as straightforward as we can.

-And Nevada did have some choice in how this was implemented.

Can you explain in what ways?

What choices did Nevada make as far as how this will be implemented?

-So, firstly, states have the option to determine how long does someone have to meet work requirements to still be eligible.

States could pick between one month and three consecutive months of eligibility.

Nevada selected one.

That's because it's really aligning with our economic landscape.

We recognize there is a lot of seasonal work in our state, a lot of shift work that can be complicated to represent on paper, and so we wanted to make that as straightforward as possible.

We also have choice in how exactly we define our medically frail exclusion, which we've worked with our provider community and community partners to define in a way that best aligns with Nevada's needs and goals.

And we also had a choice in terms of how we evaluate our renewals.

So the other change that's coming as a result of HR 1 is that people in our adult expansion population, so about 260,000 Nevadans, will move from an annual cycle of how frequently they renew their coverage to every six months.

States had a choice to reset everyone's renewal date on January 1st or to keep their currently scheduled renewal date and to move to that six-month cadence afterwards, which is the option that Nevada picked.

Our goal is to minimize disruptions to what people are already planning in their process.

What this means is people's renewal dates in which they have to potentially meet work requirements will fall throughout 2027, not all on January 1st.

That allows us time to learn quickly, to make any necessary adjustments to our public communications campaign, and to make sure that people are already planning for their renewal dates are able to go through the process and have a very clear next renewal coming up in six months after that.

-And I have one more question.

What is the expected impact on rural Nevadans?

-Absolutely.

Our rural expansion population is much smaller.

We're working to put data on our website that shows a breakdown by county of people that we think may need to actually provide information about work requirements in their renewal in 2027.

I will say Nevada has also selected another state choice that we made was to select to opt into what's called short-term hardship exceptions.

These are four very specific categories in federal law that states had the option to choose, and Nevada did choose to opt in to implementing those.

And we believe it's the right choice, particularly for our rural population.

Those exclusions include having to travel a long distance for care or having a recent hospitalization, living in a county with high unemployment rates, which in Nevada will apply to Mineral County, and we're continuing to evaluate if it applies to others.

And so we're doing everything we can to recognize that our rural communities already do face many barriers to accessing healthcare.

We want to make sure we're supportive with them and through that process.

So we're working very closely with our rural hospital association, the Nevada Association of Counties, and others to ensure that all of our rural communities are well prepared when these changes go into effect.

-The Nevada Medicaid website is available in a number of languages, including Spanish.

Just use the language drop-down menu at the top of the page.

Nevada Medicaid says it also offers free language assistance.

We move now to Veterans Day and the crucial role of caregivers.

The Elizabeth Dole Foundation estimates there are 14.3 million military and veteran caregivers in the U.S.

That's about 5.5% of all U.S.

adults.

Former U.S.

Senator Elizabeth Dole started the foundation in 2012 after seeing caregivers' struggles firsthand when her husband, the late Senator Bob Dole, had to spend nearly a year at Walter Reed.

Each year, her foundation selects a class of Dole Caregiver Fellows--they're military and veteran caregivers who become advocates for others in their position--and this year's class of 23 caregivers from 19 states includes Las Vegas caregiver Serena Guimarey.

(Unknown speaker) Is it goat cheese?

-I think it is goat cheese.

-The Guimareys have a busy household; and in 2023, they added another member.

(Paul Dannenberg) I've been here for three years, and it's a godsend.

-Paul Dannenberg, whose grandchildren call him Papa, is a U.S.

Army Vietnam veteran.

(Serena Guimarey) As a result of being in the Vietnam War, he was exposed to Agent Orange, which led to him having cancer.

And he has dementia, diabetes, neuropathy, high blood pressure as well.

-Serena Guimarey is Dannenberg's daughter, and she's also his caregiver, a role she assumed when she reshuffled her life and moved him into her Las Vegas home.

-He was in the veteran home down in Boulder City, and my oldest daughter would drive on her own to go visit him.

And one day she came home, and she was just like, "Why?

Why does Papa have to live here?

Why can't you move him in with us?"

-I started to notice that my papa wasn't really himself anymore.

He seemed a little more quiet.

He didn't seem like he was fully enjoying himself, and so I came home one day and I told my mom that I think we need to move him into our house.

-Becoming a full-time caregiver, I did have to make a change to my typical traditional work.

Luckily, the VA does offer a program.

They have two programs.

So they have PCGSS, which is a general service program to support caregivers.

Most everyone gets into the general.

And then they have a stipend program called PCAFC.

And luckily, we were able to qualify for that.

And so then I have a stipend that I receive, which really helps, obviously, our family to be able to sustain.

(Amber Renee Dixon) Testifying before Congress last year, the head of the VA's caregiver program said the VA receives about 9,000 applications for caregiver stipends each month and only approves about 30 to 33% of them.

-It's a difficult program to get into.

Luckily, the Elizabeth Dole Foundation has a resource that helps caregivers go through the process to reapply to appeal the decision.

-This year, the Elizabeth Dole Foundation named Serena Guimarey a Dole Caregiver Fellow, recognizing her work to support caregivers of aging veterans like her father.

-But that's the kind of person she is.

She works very hard.

And there's a need for it.

-Although the VA provides excellent healthcare, I think the biggest challenge is the VA system, right, is navigating that VA system.

And I feel that's where our veterans fall through the cracks and don't get the service that they need.

I know I experienced that myself as being my dad's caregiver.

I had about a month-long battle, if you will, with the VA to secure him his therapeutic shoes that he needs.

And one of the days it was eight hours on the phone.

-Serena is what the Elizabeth Dole Foundation calls a hidden hero--and her children, hidden helpers.

-He likes my grilled cheese the best.

He always, he always says that.

-We play cards every night.

We do jigsaw puzzles.

He builds Legos.

I think having him here is great for his mental health, and I also think it's amazing for my kids, right, to see that we do these things for our parents.

-I know they like me, the way they treat me.

-The Guimareys say their papa lets his gratitude be known.

-He tells us, like, every-- He tells us every night.

When I go in to say good night, he always says, like--he always says he loves you so much and that he's just so grateful.

-And his caregiver and daughter says it's an honor.

-Because it's a privilege to be able to serve him.

Like, it brings me joy to serve my dad.

-For Serena's father, home meant moving in with family, but not every veteran has that option.

This year's homeless count found more than 600 veterans in Clark County without a home, up 22% from two years earlier.

U.S.VETS works to get them housed and keep them there.

Paige Miller, Executive Director of U.S.VETS Las Vegas, joins us now.

Paige, welcome to Nevada Week.

-Thank you.

It's an honor to be here.

-What do you think about that 22% increase?

What's behind it do you think?

(Paige Miller) I want to first say that 605 veterans identified through the Clark County Point-in-Time count is 605 too many veterans on the street, and our veterans who fought to defend our nation should not be experiencing homelessness.

And I think the increase in the number of veterans found in the Point-in-Time count from two years ago has to do perhaps with the methodology change, but also it's only one night where folks go out in the community and find those individuals experiencing homelessness.

So it can vary over the years.

-Do you think it's more or less than that number?

-Well, that 605 individuals includes those who are in transitional housing, and we are one of those organizations in Vegas that provides transitional housing.

But I think that the number is larger because there are individuals who we simply cannot locate.

-When you talk about veterans that you are unable to find, what do you mean by that?

-There are veterans in tunnels that run under the city of Las Vegas, and sometimes they don't want to be found or it's very difficult to convince them to come and stay with us at U.S.VETS and return to a path of stability and dignity.

-What is your outreach effort like?

-Well, in fact, outreach is our first interaction with clients.

And every week, five days a week, we have an outreach team that goes out into the tunnels, in the encampments, libraries, prisons, and hospitals, looking for veterans who are at risk of experiencing homelessness or who are unfortunately currently experiencing homelessness.

-Why do people not want the help?

Why do these veterans say that?

-These veterans have led a life of service, and they're very self-reliant.

And so sometimes it's not easy for them to ask for help or accept that help.

But we don't give up, and we continue to build the relationships with those veterans we find in the streets and the tunnels until they are willing to accept help from U.S.VETS.

-It sounds hard to believe they'd prefer living in a tunnel than having a home.

-It's something that they've become accustomed to.

And when you talk to clients who were literally homeless the day before, they have fascinating stories that led them to live like that.

And they have their own little arrangements in the tunnels and on the streets and communities that they've built.

And a lot of them do suffer from mental health challenges, which is an impediment for them to seek help.

-And I would think, okay, if you're a veteran, you should have the benefits to get treatment for mental health.

But it's probably not that easy.

Can you explain how that works?

-I can, yes.

So there are benefits that the VA provides, but oftentimes veterans are not aware of those benefits.

And so they don't know that they can receive healthcare from the VA, and they don't know that they can have a disability rating, which gives them a certain percentage of income every month that's not taxed.

And so there's other barriers; some of them include not knowing where to go to seek that healthcare or transportation challenges.

-What about realistically if they do get help from the VA or seek it for mental health?

What's that timeline like?

How long does it take?

-When our clients come in, some of them who are literally homeless lack documentation to prove that they were even in the military.

So we begin that journey with them by assigning them a case manager who walks with them down that path of independence.

So we help them obtain the DD-214 document that proves their military service and obtain a driver's license or a birth certificate that they may have lost, even if they remember what state they were born in.

And that's just the first step of their journey.

And then helping them find those medical services that are available and, again, encouraging them to have the willingness to accept whatever medical diagnoses may come their way.

-What is that timeline like from actually contacting the VA and then getting help?

Because for many Southern Nevadans, it's difficult to get mental health treatment because of the lack of providers.

-The VA is a wonderful partner, and we are very fortunate that they fund us and other organizations in Southern Nevada.

And so we work closely with them to expedite that process so veterans are receiving some type of healthcare, whether it's in the community or through the VA.

-I'm glad you brought up funding.

How are you funded at U.S.VETS Las Vegas?

-At U.S.VETS Las Vegas, we are 81% funded by the VA and HUD.

-That can be difficult because HUD funding is dependent on Congress, right, and the President?

And right now, it seems to be a little bit up in the air as to what's coming down.

How do you deal with that, the uncertainty?

Where do you stand right now with your funding?

-We're fortunate to have funding right now.

The VA and HUD selected us to receive grant funding again, and we're very fortunate for that partnership.

But we are aware at U.S.VETS that funding levels can change, as you said.

There's administration changes and decisions that are made in Washington; and so in order to avoid any federal funding gaps, we also seek funding from donors, foundations, the casinos, and individual donors.

-And that, too, can be hard amid high prices and current economic conditions, finding people willing to part with their money.

And they have so many different options for donating.

You provide transitional housing, correct, also permanent supportive housing?

What does that mean, permanent supportive housing?

-This is a wonderful question.

Transitional housing means that we can have our veterans at our main site, which houses 132 clients, four to a room, and they were literally homeless when we found them.

And they come in and they begin their journey of independence and stability, as I mentioned before.

Permanent housing, or permanent supportive housing, is our ultimate goal for most of our clients.

Sometimes they also wish to obtain employment, which we help them through our workforce development program.

But the permanent supportive housing program gives them the opportunity to have a lease directly in their name with a landlord, and then they feel that they've regained that independence by having that property.

-And can that be a form of helping, a landlord contacting you and saying they're willing to participate and perhaps-- Well, how does that work?

-Yes.

Affordable housing is a big challenge here in Southern Nevada for all nonprofits and individuals who need to have affordable housing.

We are looking for landlords and property managers who are willing to partner with us, where they know that we can support those veterans in their journey and pay for their rent and their security deposit.

-Would you at U.S.VETS Las Vegas rather have funding for more permanent supportive housing or the transitional housing?

-Well, actually, our goal is to have a permanent campus.

We've been operational for 25 years.

We just celebrated our 25th anniversary, and we're spread out in the city at four locations.

But our goal is to have one campus where all of these programs can be together, so veterans who are in transitional housing can also see the successes of their neighbors in the permanent supportive housing.

-Has that been submitted as a proposal to any government entity?

-It's a work in progress, and so I'd love to be able to meet individuals who are willing to donate land or introduce us to people in the community--decision makers, politicians--who can help us find that land, whether it's donated or it's something we can purchase.

-Tell me about your Stand Down event and what it accomplished this year.

-Our Stand Down event is actually a community event where we bring together more than 200 registered service providers to support veterans in the community.

You do not have to be a veteran experiencing homelessness to attend.

It's any veteran in the community can come and obtain medical services for themselves or their animals.

There's mobile showers, meals, clothing, legal services.

And we had-- Last year we had more than 400 veterans attend.

-Wow!

-Yes.

-And from what I read, the purpose is to take care of a lot of problems all in one day.

-That's right, a one-stop shop.

-And veterans feel comfortable coming forward for this?

-Yes.

It's a remarkable program, an event that is not possible without the entire community.

-How can the community help your cause?

-Of course, financial donations are always appreciated, but the community can help volunteer.

They can come to our transitional housing site and serve meals.

We do serve three hot meals there every day.

We have a variety of programs that our clients can enjoy, such as Combat Coffee, yoga.

This is part of our therapeutic community, and so we're looking for volunteers.

-Paige Miller, Executive Director at U.S.VETS Las Vegas, thank you for joining Nevada Week.

-Thank you very much.

-Finally on Nevada Week, the Nevada State Veterans Memorial is now open at its new permanent home, the Thunderbird Family Sports Complex in Northwest Las Vegas.

The memorial features 18 bronze statues honoring American military service from the Revolutionary War through present day.

These statues once stood outside the Grant Sawyer State Office Building near downtown; but when that building closed, they sat in storage more than two years.

Now they're the centerpiece of an open-air promenade with an amphitheater.

City of Las Vegas Ward Four Councilwoman Frances Allen Polanski was instrumental in getting the memorial its new home and says, for her, it was personal.

(Frances Allen Polanski) My father would be proud.

As a U.S.

Army veteran, he was very proud of his service.

He encouraged my brother to serve, also an Army veteran.

And if nothing-- If I didn't do nothing else in my life, I know that this is probably the most important thing I've ever done and ever will do.

-Unlike the memorial's previous location, its new home will be open 24 hours a day, seven days a week, which will allow visitors to see the statues lit up at night as the artist originally intended.

We want to thank you for watching.

And a thank-you to our veterans as well.

For more information on any of the resources discussed, including links to Nevada Medicaid and U.S.VETS, go to vegaspbs.org, and we'll see you next week on Nevada Week.

♪♪♪