Fifty-first. That’s Nevada’s ranking in Mental Health America’s latest annual report, published last year. For years the state’s prevalence of mental illness has run up against, and created friction with, a dearth of accessible services.
Measures of Nevada’s continued struggle toward more ubiquitous, better funded, and attainable mental health programs are disconcerting. UNR’s Nevada Health Workforce Research Center estimates that more than 91 percent of the state’s population lives in a federally designated mental health professional shortage area. Though only 7 percent of Nevadans with mental illness are uninsured, almost 33 percent of residents with significant mental health burdens report being unable to see a doctor because of prohibitive costs — even with insurance.
Now, providers are expressing concern that federal-level funding cuts combined with Medicaid changes, mandating all able-bodied adults log 80 hours of work monthly, could create even more suffering for Nevadans seeking mental health care.
“We’re at an inflection point,” says Priscilla Otoo-Adjorlolo, director of behavioral health at The LGBTQ+ Center.
On the night of January 13, the Substance Abuse and Mental Health Services Administration (SAMHSA) abruptly cut, then restored, $3.5 million in grant funding for The Center’s mental health and substance abuse services. SAMHSA blamed the grant’s mission as no longer being in alignment with that of the agency. The temporary disruption felt like whiplash.
“The staff were freaking out. You just went home and now you have no job,” she recalls. “How can we treat those that come to us for needs (when) we ourselves are unstable?”
SAHMSA did not respond to a request for comment. But, Otoo-Adjorlolo says the agency’s threatened cuts were just one of many shakeups in the last year to have impacted staff and patient morale.
Another, more permanent obstacle, is the Trump administration’s new, more stringent Medicaid work requirements — a result of the President’s tax cuts in last year’s “One Big Beautiful Bill Act.” Otoo-Adjorlolo says this will jeopardize care for already vulnerable patients. “About 80 percent of the clients that come (to The Center) rely on Medicaid.”
Indeed, according to the Robert Wood Johnson Foundation, without intervention, that new requirement will cause nearly 150,000 existing Nevada Medicaid recipients to lose their coverage in 2028 — an estimated 49 percent decline in enrollment. Many of those patients use it for mental health care services.
“When all these millions are cut, then what’s going to happen to that one last line of defense?” Otoo-Adjorlolo asks.
That concern appears to be universal, at least among staff at UNLV Health’s Mojave Counseling clinic.
“I’m 22 years into the profession, and I haven’t seen anything this bad,” says Lisa Durette, chair of the Department of Psychiatry and Behavioral Health at UNLV’s Kirk Kerkorian School of Medicine. Durette also practices child and adolescent psychiatry at Mojave.
Mojave’s clients, too, heavily rely on Medicaid to receive clinical care. The worry, says Durette’s colleague Jason Schwartz, Mojave’s director of community support services, is that there’s no exception carved out for Medicaid recipients who are able-bodied physically but not psychiatrically.
“We’re dealing with 300 people who are psychiatrically disabled, can’t work, are losing their SNAP benefits now, are going to lose their Medicaid entirely, and won’t be able to have psychiatric treatment with us in January of 2027.”
Durette acknowledges that their patients represent only a fraction of the city’s mentally vulnerable population. “Yet, putting that health care expenditure towards these individuals helps protect against costs on the back end” — such as pricey hospital bills and law enforcement expenses. The Centers for Medicare and Medicaid Services said in an emailed statement that it is working to address families’ emerging health care needs.
If nothing changes on all fronts, the fallout for many patients could be profound.
“It’s like having a car that was in a really bad crash and saying, ‘Let’s just put a new tire on,’ but it never quite drives right,” says patient advocate Rebeka Acosta, a mom of two teenage boys who have needed mental health care — and have been unable to receive it in Nevada — for years. “(My youngest) feels that he runs on this three-month cycle” as he waits to receive mental health care in neighboring states.
In addition, Acosta says mental health providers often don’t accept insurance like physical medical providers do, and there’s no state law compelling them to. “A lot of them have decided it is just too difficult: It is not worth their sanity, their time, their money to enroll with all these insurance providers.”
Even when providers do accept private insurance plans, there’s no guarantee Nevadans can get their treatments covered. That was validated last year by the Nevada Division of Insurance, whose annual investigation, first reported on by the Nevada Independent, found more than a dozen of the state’s major insurance companies violated a federal law requiring coverage parity between mental and physical health services.
Compared to medical and surgical services, mental health and substance abuse ones had more claims denied and lower reimbursement rates, among other disparities. Investigations are ongoing, with fines up to $50,000 possible.
For now, though, in an effort to diversify as much as possible, publicly funded mental health programs are continuing to look for alternate streams of revenue, either through reapplying for other state and federal grants or by petitioning private donors.
“We are always very aggressively looking towards every avenue under the sun for sustainability,” UNLV’s Durrette says.
Similarly, the state is attempting to fill gaps where it can. During the last legislative session, Nevada joined a counseling compact with more than 30 other states. The compact, which went into effect at the start of this year, permits licensed mental health counselors in other states to practice in Nevada. And other new laws, such as SB165, attempt to bolster the state’s ranks of homegrown mental health providers through more local degree programs and internships.
Time is of the essence, though.
“When funding disappears, people don’t just lose services,” The Center’s Otoo-Adjorlolo says. “They lose stability. Safety. In many cases, they lose their lives.”
