Managed Care in Nevada

The Department of Health and Human Services is evaluating alternative service delivery models aimed at achieving better care for patients, better health for our communities and lower costs through improved health outcomes. The Division of Health Care Financing and Policy (Nevada Medicaid) currently provides services under two different delivery models, Fee-For-Service and Managed Care. A Managed Care Organization arranges for a medical service provider to provide health care services to individuals enrolled in their organization. Nevada Medicaid currently contracts with two Managed Care Organizations (MCO’s): Health Plan of Nevada and Amerigroup. If you are on Medicaid and you live in urban Washoe County (Reno) or Clark County (Las Vegas), managed care enrollment is mandatory unless you are under the special Medicaid category of aged, blind or having a disability, determined by the Division of Welfare and Supportive Services (DWSS) as part of your Medicaid application process.

Your MCO contracts with some doctors but not all doctors, and you must use a doctor that is in your MCO’s network. Managed Care covers most of the services that are in the Medicaid-approved State Plan and have the flexibility to offer additional services based on need and the plan selected. Services not currently covered by Managed Care include Hospice, Adult Day Health Care, Non-Emergency Transportation, Targeted Case Management, Home and Community-Based Waiver Services, Intermediate Care Facilities for Individuals with Intellectual Disabilities, Nursing Facility Stays more than 45 days, Orthodontia and Residential Treatment Center stays more than 30 days. Options the State may consider for the future are expanding Managed Care statewide, including additional services that are not currently covered by managed care, expanding the population served by managed care to include aged, blind, or individuals with disabilities and/or increasing the number of Managed Care Plans to offer greater choice and flexibility of services.

The Division of Healthcare Financing and Policy (Nevada Medicaid) will be hosting a series of town hall meetings/listening sessions across the state in the coming months to gather feedback on the options up for consideration. After hearing public comments, final recommendations will go to the Legislature and the Governor in late 2016.

For more information and schedule of town hall listening sessions visit http://dhcfp.nv.gov/.

Specific questions or comments can be emailed to ManagedCareExpansion@dhcfp.nv.gov.

To receive automatic updates on  Managed Care via email go to http://dhcfp.nv.gov/Pgms/LTSS/MCE/MCEListserv/.