How Nevada pays for disability services

Waiver inventory

The Frail Elderly and Physical Disabilities waivers are listed for completeness of the HCBS landscape but are not Nevada's vehicle for people with developmental disabilities. Nevada's Aging and Disability Services Division also delivers Targeted Case Management to people eligible for Developmental Services under the Medicaid state plan, performed by Regional Center Service Coordinators who are state employees (https://adsd.nv.gov/programs/developmental-services/service-coordination/). No 1915(i), 1915(b)(3), 1915(k)/CFC, or 1115 authority for IDD was identified.

State-only funded programs

• Family Preservation Program (budget account 3166). Monthly cash assistance to families caring at home for a relative with a severe or profound developmental disability, and to children under six with developmental delays requiring equivalent support, at or under 300% of the federal poverty level. SFY2026 legislatively approved total $3,779,136, of which $2,644,673 is state General Fund and $1,134,463 other. Projected caseload 651 in SFY2026, up from 648 in SFY2025, rising to 655 in SFY2027. Administered by ADSD through the three Regional Centers. adsd.nv.gov and budget.nv.gov
• Family Support Services. Quarterly respite vouchers and emergency Purchase of Service vouchers for families at or under 300% of the federal poverty guidelines who care for a relative at home. Purchase of Service vouchers cover food, uncovered medical and dental services, special diets, adaptive equipment, and utilities, and are "subject to state funds availability." Administered by ADSD Regional Centers. Separate appropriation not identified; funded within Regional Center budget accounts. adsd.nv.gov
• Autism Treatment Assistance Program (ATAP) (budget account 3209). Monthly allotments to providers for evidence-based autism treatment including Applied Behavior Analysis, Verbal Behavior, and Pivotal Response Treatment for children under 20, plus speech, occupational, and physical therapy where no other coverage exists. SFY2026 legislatively approved total $11,986,796, of which $8,399,600 is state General Fund; SFY2027 $12,705,146 with $9,078,215 General Fund. Staffing 55 FTE in SFY2026, 57 in SFY2027. adsd.nv.gov and budget.nv.gov
• State General Fund share of Regional Center services for people who are not Medicaid eligible or who need services the waiver does not cover. The three Regional Center budget accounts carry a combined $232,133,847 in General Fund in SFY2026 against total budgets of $431,604,297, a General Fund share of about 54%, which is well above the state share implied by the FMAP and indicates substantial non-matched state spending. budget.nv.gov

County / regional / local funding

None identified as a distinct local revenue stream. Nevada's sub-state structure is the three state-operated Regional Centers, funded through state budget accounts, not county levies or local boards:

• Desert Regional Center (BA 3279), serving Clark County except outlying rural areas. SFY2026 legislatively approved $294,896,550 total, $157,326,317 General Fund, 472.57 FTE. Projected caseload rising from 6,147 in SFY2025 to 6,542 in SFY2026 and 6,950 in SFY2027.
• Sierra Regional Center (BA 3280), serving northern Nevada. SFY2026 $98,083,550 total, $53,291,830 General Fund, 97.02 FTE. Caseload rising from 1,943 in SFY2025 to 2,089 in SFY2026.
• Rural Regional Center (BA 3167), serving all rural counties and most outlying rural areas of Clark County. SFY2026 $38,624,197 total, $21,515,700 General Fund, 51.76 FTE. Caseload rising from 853 in SFY2025 to 866 in SFY2026 and 878 in SFY2027.

Sources: budget.nv.gov and adsd.nv.gov

No Nevada county mill levy, county board of developmental disabilities, or county general revenue stream for IDD services was found.

Funding scale

• Total Developmental Services SFY2026 legislatively approved: $431,604,297 across the three Regional Centers, of which $232,133,847 is state General Fund and $199,470,437 is other funds including federal Medicaid. SFY2027 total $429,462,796. Derived by summing BA 3279, BA 3280, and BA 3167. budget.nv.gov
• Adding the Family Preservation Program ($3,779,136) and ATAP ($11,986,796) brings SFY2026 IDD and autism spending to roughly $447.4 million.
• Combined Developmental Services caseload SFY2026: 9,497 people (6,542 + 2,089 + 866). This includes both waiver participants and people receiving state-funded Regional Center services.
• IDD waiver enrollment: 2,711 active, 548 on the waitlist as of February 2024. This is the most recent published waiver-specific count found. leg.state.nv.us
• ATAP projected caseload: 12,957 in SFY2025 rising to 13,962 in SFY2026 (7.69% increase) and 14,754 in SFY2027, as stated in the budget. These figures appear to be summed monthly counts rather than unduplicated children. budget.nv.gov
• FMAP FY2026: 59.80%. kff.org
• Related ADSD accounts: Early Intervention Services (BA 3208) SFY2026 $51,298,578 with $44,254,663 General Fund and 202.13 FTE. budget.nv.gov
• Spending per participant: not published as such. Dividing the SFY2026 Developmental Services total of $431,604,297 by the 9,497 projected caseload yields roughly $45,400 per person, but this blends full waiver residential placements with people receiving only service coordination or family support, so it is not comparable to a waiver-only per-participant figure.
• Waiting list: 548 for the IDD waiver as of February 2024, up from 412 in January 2022. Average wait time not published. leg.state.nv.us and leg.state.nv.us

Residential funding detail

Nevada funds residential support through the Supported Living Arrangement (SLA) program, delivered by agencies under contract with the Regional Centers (https://adsd.nv.gov/programs/intellectual/sla/sla/):

• Intermittent SLA: several hours per week up to daily support while the person lives alone, with a roommate, or with family. Hours are set by the team's assessment. Billed as T2017, Habilitation Residential Waiver, 15 minutes at $9.77 base, $11.52 with the TN rural modifier, $10.83 with TG, and $4.89 with the UJ modifier.
• 24-hour SLA: staff present whenever residents are home, with awake or asleep overnight staff depending on need. People typically live with roommates in a community neighborhood and share provider support. Billed as T2016, Habilitation Residential Waiver, per diem.
• Host Homes: the person joins a Host Home provider's family life and activities, with direct support to acquire, retain, or improve community living skills. Also billed under the residential codes.

Payment structure for 24-hour residential is a per diem with acuity and setting modifiers, not hourly. The T2016 per diem grid uses U1, U2, U3 as base levels, TN as a rural or differential modifier, and UQ and UP as higher-intensity modifiers, producing a ladder from $142.00 to $457.75 per day, plus a UC rate of $1,800.00 per day for the most intensive authorizations. Effective date across the grid is April 1, 2024.

Institutional. The Intermediate Care Facility at Desert Regional Center is a 10-home residential campus serving 41 residents with 24-hour staffing for adults 18 and over with significant medical or behavioral needs, funded through Medicaid. adsd.nv.gov The 2025-2027 budget includes a Desert Regional Center decision unit funding costs to support the Intermediate Care Facility.

Room and board. Not found in retrieved sources. Nevada does not publish an SLA room and board policy comparable to New Hampshire's. Federal rules bar Medicaid payment for room and board in HCBS settings, and the T2016 and T2017 rates are habilitation rates, so shelter and food costs fall to the person's own income, typically SSI. I could not confirm a state-funded room and board subsidy.

Rate structure link: nevadamedicaid.nv.gov

Comparable service rates

Also on the Provider Type 38 schedule: Prevocational Habilitation (T2047) $2.78 to $10.04 per 15 minutes, effective April 1, 2024; Wellness Assessment (S5190) $6.39 to $102.28 depending on modifier, effective October 1, 2024; Non-Emergency Transportation (T2003) $6.17 to $108.74 per trip, effective April 1, 2024; Nutrition therapy (97802/97803) $19.63 to $26.57 per 15 minutes, effective July 1, 2023.

Official rate schedule links

• Provider Type 38, Waiver for Individuals with Intellectual Disabilities and Related Conditions, reimbursement schedule effective July 2026: nevadamedicaid.nv.gov
• Provider Type 55, Home Based Habilitation Services, reimbursement schedule effective July 2026: nevadamedicaid.nv.gov
• Provider Type 22, Dental ID Waiver fee schedule: nevadamedicaid.nv.gov
• Provider Types 30 and 83, Personal Care Services fee schedule: nevadamedicaid.nv.gov
• Nevada Medicaid fee schedule index: nevadamedicaid.nv.gov
• ADSD Service Agreement Provider Rates page: adsd.nv.gov
• ADSD Developmental Services rates, Jobs and Day Training and Residential, dated July 17, 2018: adsd.nv.gov
• Provider Type 55 billing guide: medicaid.nv.gov
• Provider Type 38 billing guide: medicaid.nv.gov

Notable features and flags

• April 1, 2024: The great majority of IDD waiver rates on the Provider Type 38 schedule carry an April 1, 2024 rate begin date, indicating a comprehensive repricing on that date. Rates remain unchanged through the July 2026 posting, meaning no increase took effect for SFY2027. nevadamedicaid.nv.gov
• October 1, 2023: The current IDD waiver period began under CMS approval NV.0125.R08.00, approved September 28, 2023 and running through September 30, 2028. The most recent approved application was updated August 18, 2025. medicaid.gov
• SFY2026 and SFY2027 budget: The Legislature added three new Developmental Specialist positions at Rural Regional Center, nine at Desert Regional Center, and five at Sierra Regional Center specifically "to conduct standardized assessments to meet new federal minimum benchmarks for functional needs assessments required for Developmental Services," plus five new Developmental Support Technicians at Desert Regional Center. budget.nv.gov
• SFY2026 and SFY2027 budget: Desert Regional Center decision unit E499 shows a $1,741,888 addition in SFY2026 and a $4,556,717 reduction in SFY2027 tied to an "Ackerman Center - Autism Foundation project," and E270 reduces Title XX funding that no longer supports Jobs and Day Training expenditures at Rural Regional Center. budget.nv.gov
• Waitlist growth: The IDD waiver waitlist grew from 412 in January 2022 to 548 in February 2024, a 33% increase, even as active enrollment grew only from 2,582 to 2,711. Nevada has no publicly announced waitlist elimination initiative comparable to Nebraska's. leg.state.nv.us and leg.state.nv.us
• Rate study status: DHCFP's rates page references a 2020 IID waiver cost study by Burns & Associates and notes that "rate changes would need to [be] approved by the legislature next session." Assembly Bill 108 of 2017 requires Nevada Medicaid to perform comprehensive rate reviews on a rolling schedule. dhcfp.nv.gov

Confidence

Solid: the SFY2026 and SFY2027 legislatively approved budget figures by budget account, including General Fund and total amounts, FTE counts, and projected caseloads, all taken directly from the Budget Division's approved biennial budget document; the complete Provider Type 38 rate grid with modifiers and rate begin dates, parsed from the state's own spreadsheet; the ICF at Desert Regional Center census of 41 across 10 homes; the FY2026 FMAP; and the descriptions of SLA, Family Preservation, Family Support Services, ATAP, and Service Coordination from ADSD program pages. Estimated or derived: the $431.6 million Developmental Services total and the $232.1 million General Fund figure, both of which I summed from the three Regional Center budget account totals; the $45,400 per-person figure, which is a crude quotient and mixes service intensities; and the interpretation of ATAP's 13,962 caseload as a summed monthly count rather than unduplicated children. Could not find: IDD waiver enrollment or waitlist figures more recent than February 2024, an ICF/IID per diem rate, a Nevada room and board policy for SLA settings, an appropriation figure specific to Family Support Services, an IDD waiver respite rate, and confirmation of the statutory authority under which Provider Type 55 Home Based Habilitation Services is furnished. The CMS approved waiver application ZIP for NV0125 returned a 403 and could not be opened, so I could not retrieve the waiver's own cost-neutrality tables.

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