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Covering Nevadans when they need it most

Medicaid in Nevada

Nevada Medicaid plays a vital role in improving the health and wellbeing of some of the state’s most vulnerable. In Clark and Washoe Counties, Medicaid is administered through the managed care model.1

All MCOs are accredited and regularly reviewed by the National Committee on Quality Assurance (NCQA). Additionally, the Nevada Legislature and Department of Health and Human Services provide oversight to MCOs and the Medicaid program.

Program history

In Nevada, MCOs are held to high standards by the state and are accountable for the quality of care they administer.

1997

Managed care program initiated2

2014

Nevada expands its Medicaid program to include low-income adults without children3

2020

Three MCOs service Clark and Washoe Counties4

Program population

Helping 464,000+ in Nevada5

MCOs are responsible for program administration, including network management, claims payment, care coordination, and utilization management. 75% of Medicaid recipients are cared for by MCOs in Nevada.6 Medicaid managed care and CHIP cover more than 250,000 children in the state.7

Reduced costs

Making the budget predictable

With the cost of healthcare rising, managed care organizations help states better plan and manage their budgets. MCOs are paid a per member per month fee that helps states predict how much they will spend on Medicaid each month.

Improved population health

A higher standard for Nevada

32%

increase in counseling for nutrition and physical activity

MCOs work to treat the whole person, with a keen focus on preventive services, which save lives and costs.

From 2015 to 2018, among Nevadans in Medicaid managed care, there was a 32% increase in counseling for nutrition and physical activity, and a 14% increase in infants receiving six or more well-child visits from their primary care provider in their first 15 months.8

The number of adolescents who received well-care visits improved 11% between 2015 and 2018, meaning more support for healthy young people and improved likelihood of catching health hazards and conditions before they advance.9

Patient experience

Coordinated care for Nevadans

MCOs coordinate care and provide a single point of contact for Nevadans, creating a better patient experience.

MCOs bring together disparate parts of the delivery system, which allows for comprehensive management that includes partnering with community groups to address social determinants of health. In Nevada, MCOs offer 43 additional services for Medicaid recipients compared to non-managed care models. These services include bus passes, transitional housing, and wellness incentives.10

MCOs also improve access to care through expanded telemedicine and telehealth, new community paramedicine programs, and mobile clinics.

89%

of parents with children in Medicaid managed care rated their health plan 8 out of 10 or higher in satisfaction.11

Provider experience

Helping states help providers

Through Medicaid managed care, providers benefit as well. MCOs use value-based payment models that incentivize, empower, and reward providers for the quality of care, not the quantity.

In Nevada, 97% of clean claims are paid to providers within 30 days.12

Downloads

About Medicaid Managed Care in Nevada

pdf 128.34kB

Sources

  1. “State Fiscal Year 2018-2019 External Quality Review Technical Report,” Division of Health Care Financing and Policy | Nevada Medicaid Managed Care, 2019.
  2. “State Fiscal Year 2018-2019 External Quality Review Technical Report,” Division of Health Care Financing and Policy | Nevada Medicaid Managed Care, 2019.
  3. “Nevada Medicaid 101 & Rate Reviews,” Marta Jensen, Administrator, Division of Health Care Financing & Policy Jared Davies, Chief, Rate Analysis & Development, DHCFP, 2018.
  4. “Managed Care and Dental Health Plan,” Nevada Department of Health and Human Services Division of Health Care Financing and Policy, 2022.
  5. “Medicaid Chart Pack,” State of Nevada Department of Health and Human Services Office of Analytics, 2022.
  6. “Medicaid Chart Pack,” State of Nevada Department of Health and Human Services Office of Analytics, 2022.
  7. “State Fiscal Year 2018-2019 External Quality Review Technical Report,” Division of Health Care Financing and Policy | Nevada Medicaid Managed Care, 2019.
  8. HEDIS Data, 2015-2018.
  9. HEDIS Data, 2015-2018.
  10. “Managed Care and Dental Health Plan,” Nevada Department of Health and Human Services Division of Health Care Financing and Policy, 2022.
  11. CAHPS Member Survey, 2019.
  12. MCO Contractual Terms.