Breaking Point: Nevada’s Fragile Healthcare System
Nevada has been named one of the fastest-growing states in the country, but the healthcare system is failing to keep up—and the cracks are beginning to show. The healthcare infrastructure is dysfunctional at best. Changes are being made, but will they make a difference?
The Nevada Department of Health and Human Services (DHHS), the state’s largest and most costly department, oversees more than $6 billion in annual spending for the welfare of Nevada’s most vulnerable populations. Yet despite this massive budget, oversight has been weak, money has been mismanaged, and accountability has been largely absent. Since 2015, under the long-term leadership of Director Richard Whitley, many of these problems have only deepened rather than improved.
The recent decision to split the agency into two separate authorities has added yet another layer of confusion for the public. For the end user, this change doesn’t mean better services; it means more bureaucracy, more red tape, and more uncertainty. And now, with a new Managed Care Organization scheduled to roll out across Nevada’s rural regions on January 1, 2026, communities that have gone without meaningful services for over a decade are being asked to put their trust in a system they don’t understand. Most rural residents have never been told what an MCO is, let alone what it could do to improve their lives. Meanwhile, DHHS or its newly renamed counterpart, DHS, has done little to engage directly with the very people it claims to serve. Instead of education, outreach, and support, Nevadans get cosmetic fixes: new names, new software and policy shifts that fail to address the real problems.
The consequences are severe. Mismanagement has pushed high-fidelity providers out of Nevada, taking with them the tax revenue the state desperately needs. At the same time, the number of mental health and behavioral health providers and facilities that remain is far too low to meet the demand. Rather than strengthening the safety net, DHHS’s actions have weakened it—leaving vulnerable populations underserved while creating an unstable and unsustainable care environment.
New Decade, Same Problems
DHHS represents 36% of the state budget, yet fiscal transparency remains elusive. While the department is quick to cite funding constraints, a pattern of weak accountability has been ongoing for years. From COVID-19 missteps to the youth behavioral health crisis, it’s clear that these state agencies are running without transparency or accountability.
Nevada DHHS has increasingly pulled back authority from trusted nonprofits, counties, and private partners, opting instead to “take back” contracts and bring services in-house. But insiders are concerned the programs taken over by the state will impact service delivery, especially in rural areas. Insourcing gives DHHS greater control, but it strips the voice of experts in our communities, including trusted nonprofits and private partners; the problems still persist. Youth mental health services remain in disarray, and case management for medically fragile individuals has been halted for months, following staff shortages and bureaucratic delays.
Adding to the instability is a chronic leadership vacuum and constant turnover, which is bad for business. Key roles within DHHS divisions, especially those overseeing aging, behavioral health, and child services, and substance abuse programs are often vacant or filled by interim staff with little relevant experience. DHHS employees, especially those in direct care roles, often earn poor wages, with Nevada’s reimbursement rates being some of the lowest in the country. And the employees who do quit are citing an environment of abuse and intimidation. According to the State, “The department's Medical, Health and Related Services occupational group represents the highest overall vacancy rate (34.42%), followed by the Social Services and Rehabilitation group (30.81%). Together, these two groups make more than 65% of the DHS vacancy rate.”
Incidents the State Wants to Forget
Mismanaged Money
Federal funds make up 27.7 percent of Nevada’s 2023-2025 budget (roughly $14.8 billion), with 80% of those funds going directly to DHHS. Nevada also received over $1.1 billion in settlement funds from companies engaged in the opioid crisis, including another $58 million earlier this year. DHHS determines who receives the opioid settlement funds. The Review Journal reports, “Of those settled funds, $462.2 million will go to the state’s Fund for a Resilient Nevada, and $370 million will go to cities and counties part of the One Nevada Agreement.” Many providers, grassroots organizations and non-profits were sidelined in the process, and overdose deaths remain high in rural and underserved populations. In fact, overdose deaths have increased in many Nevada communities.
It’s not just the numbers that haven’t improved. The Independent found that, “opioid advocates and experts are now ringing the alarm over the state’s proposed two-year budget, saying it uses $10 million of the $870 million in opioid settlement dollars in a way that potentially violates settlement agreements and opens the state to lawsuits and loss of the funds.”
Now, with federal funding hanging in the wind and Nevada having some of the worst reimbursement rates in the country, managing the money that does come in is even more important. Whitley insisted the department was prepared for a funding freeze earlier this year. Advocates and county officials, however, warned the move would undermine services just as demand for mental health care, homeless services, and re-entry support is peaking. Furthermore, the state’s delayed and incorrect Medicaid code updates are affecting cash flow, leaving even more providers threatening to leave the state.
Unlicensed and Unregulated Group Homes
In 2018, a state legislative audit revealed serious problems with the number of unlicensed homes in Nevada—many of which had no inspections, no regulations, and no support, despite housing clients with severe mental illness. Despite numerous reports, whistleblower complaints, and mounting public scrutiny, DHHS failed to regulate or even track the growing number of unlicensed group homes across every Nevada county.
At the time, The Nevada Independent reported that, “Lawmakers were angry, frustrated and upset at a… meeting where legislative auditors presented a 69-page report on the squalid living conditions they identified in their inspections of 37 of the 105 community-based living arrangement homes in Nevada.” Some of those homes include feces smeared on the floor with residents living in mold, broken glass, dirty mattresses, and insects living on broken doors and picture frames.
After the damning report became public, state officials closed 18 state-regulated community-based living arrangement homes in 2018. Now, more than seven years later, the whispers and whistleblowers are still being ignored while many of our state’s most vulnerable populations are still living in squalor. News 8 reported on the ongoing problem in 2021, yet the problems persist. For example, in 2024, Journey To Recovery was found to be housing 17 individuals in a single-story 3-bedroom home with deplorable conditions. Evidence of problems with this organization goes back at least six years. They were under investigation in 2024, but the investigation was strangely stopped without resolution. Citizens can file a complaint, but where is the accountability from the state in answering those complaints?
Patient Dumping Problems
Patient dumping in Nevada has unfortunately been going on for years. The Rawson-Neal Psychiatric Hospital Patient Dumping Scandal began in 2013. Also known as the “Greyhound Therapy” scandal, an investigation found that “the Rawson-Neal Psychiatric Hospital in Las Vegas bused approximately 1,500 mentally ill patients out of Nevada over the past five years.” That was more than 10 years ago, but the lack of systemic reform under Whitley has allowed the scandals to continue for over a decade.
In 2022, disturbing photos of an elderly lady with a walker being dumped on the street across from UMC surfaced, sparking outrage from elected officials. In 2023, News 3 reported on a lawsuit that claimed Centennial Hills Hospital Medical Center inappropriately discharged an 87-year-old woman in the middle of the night.
The Ongoing Youth Mental Health Crisis
Nevada ranks 51st in the Nation with youth mental health services. Youth services across the state are so bad that they caught the attention of the DOJ. The Reno Gazette reports, “In 2022, the DOJ released the results of an investigation, finding that Nevada does not provide its children with behavioral health disabilities with adequate community-based services.”
The department’s investigation found that Nevada lacks needed community-based services, including intensive in-home services, crisis services, intensive care coordination, respite, therapeutic foster care, and other family-based supports. As a result, Nevada committed to making sure children who may have a behavioral health disability are screened and assessed, and provided with expanded community-based services, wraparound service coordination, mobile crisis and stabilization services, and more.
Has Nevada stepped up since the investigation? It appears not. Earlier this year, the DOJ filed a complaint against Nevada in federal court with the stipulation that the court shouldn't do anything for now, but that if Nevada doesn’t live up to its promises, the complaint will move forward.”
The Nevada Independent found that Nevada’s Division of Child and Family Services (DCFS) had worked under poor management and years of fear-mongering. After a particularly bad manager faced an internal investigation and was moved to a different department, their “return [in 2023] angered and terrified employees, who said they have lost trust in how the division handles allegations of employee mistreatment.” These actions created an environment “built on fear, retaliation and paranoia," as reported by The Nevada Independent.
Richard Whitley said in an interview that he became aware of complaints against this employee in 2019, and he takes responsibility for the decision to bring her back to a prior role, which was to oversee a program with decreasing output. “I’ll own it,” he said. However, youth continue to be warehoused in inappropriate or high-risk settings, with rising abuse allegations and provider burnout.
It’s not just DCFS facing problems with youth mental health. The state-run psychiatric facility for youth, Desert Willow Treatment Center, is just one of many state-run organizations facing chronic understaffing, mismanagement, and failed oversight. The Nevada Current found that, “Beds in state-run psychiatric facilities for Nevada’s children are empty because of a staffing shortage, and inpatient treatment has plunged by 60 percent since 2015.” Federal and state audits flagged the facility repeatedly; DHHS failed to implement long-term corrective plans, and staff whistleblowers cited intimidation and retaliation.
All this while youth continue to struggle, psychiatric beds are left empty due to staff shortages, and other community providers are facing unfair and targeted attacks from the state.
Oversight, Lack of Transparency and Unfair Targeting
Transparency and documentation of oversight practices are critical but often ignored in Nevada’s DHHS. Many providers have complained that they have been unfairly targeted by the state, while hundreds of unlicensed care homes and hospices operate in residential backyards, motels, and makeshift shelters without any oversight at all.
Meanwhile, within DHHS, state employees continue to raise the alarms about lack of oversight and transparency, intimidation tactics, and abuse. Most recently, Division of Public and Behavioral Health Administrator (DPBH) Dena Schmidt resigned, stating that she “cannot continue to be subjected to intimidation, humiliation and abusive behaviors.” When the story broke in August 2025, one Redditor wrote, “This is not surprising. The current administration seems to consider ‘intimidation, humiliation and abusive behavior’ as core business practices.” In fact, many of the comments on this story were damning. On Facebook, Schmidt’s former colleague, Michael Veprauskas wrote,
“I was a colleague of Dena Schmidt and found her to be an outstanding individual and dedicated employee. On the other hand, a former employee of mine went to [work] for Mr. Whitley and later told me it was the worst experience in their professional life. Another colleague worked for him as a division administrator and ended up having to quit because of the abuse and intimidation.
When Mr. Whitley led the health division, they had a saying, "364 and out the door." This meant that it was typical for employees to be fired just before they gained their permanent status. Someone I know was fired in this way after never having a negative employee evaluation. This set their emotional state and professional life into a tailspin. I have come to believe that Mr. Whitley is a horrible individual. Is this who Nevada wants leading its largest agency?”
Another former employee, Monica, wrote in the same Facebook thread, “As someone who has experienced it firsthand, there is corruption and abuse beyond words.” There are rumors that Schmidt is coming back, but to what end? The problems still exist, and Whitley has given no promises to do better.
What’s the State Doing About it
As of 2025, community trust in DHHS is at an all-time low. In recent years, some counties have sought ways to bypass the state entirely. Providers are withdrawing from partnerships, and patients, children, youth, seniors, and veterans are falling through the cracks. With Medicaid cuts looming, which cover more than 800,000 Nevadans, the budget will only get tighter, making transparency and accountability even more crucial.
In January 2025, Gov. Joe Lombardo and the Nevada Department of Health and Human Services announced the launch of the Nevada Health Authority as part of Lombardo's reorganization of the state's health agency.
The Las Vegas Sun reports, “Stacie Weeks, the administrator of Nevada Medicaid, will head the organization while Richard Whitley, director of the Department of Health and Human Services, will remain in his role in the newly reorganized Department of Human Services.” Several key health care programs will now be housed under the Nevada Health Authority, including Medicaid and the Children’s Health Insurance Program.
In a recent memo from the new Nevada Health Authority, Stacie Weeks states, “the goals of this new Department have been resoundingly clear since the beginning: unify similarly aligned agencies to leverage the state’s buying power, lower healthcare costs for Nevadans, bring more providers to the state, improve health care quality, and streamline services and programs.”
While some are hopeful that splitting the department will prove to be good for the state, others are more skeptical. Insiders have found that there is no formal mechanism in place to evaluate these systemic breakdowns. Whistleblowers go unheard. Data is buried. Outcomes are untracked.
Nevadans Step Up
As Nevadans, it is our job to push for government transparency. Taxpayers have a right to know how their money is being handled and how their state workers are being treated. It is up to citizens to demand more accountability. The Nevada Public Oversight Committee was launched earlier this year. Their mission is to work to expose the backroom deals, favoritism, and conflicts of interest that continue to prevent fair healthcare practices across Nevada. To learn more about their work, visit https://ncpho.org.
