Changes for Nevada Medicaid beginning January 1

For the 70,000 Medicaid recipients that live in the 15 rural counties (outside of Washoe and Clark) in Nevada, Medicaid is changing from a fee-for-service (FFS) model to managed care organizations (MCO). MCOs are private health care companies that work within a provider network, similar to alternate Medicare HMO options, and have been used by Medicaid users in Washoe and Clark counties since the late 1990s.

Medicaid is a joint federal and state public health program that provides free or low-cost health insurance for low-income households, and currently services people of all ages, including children, pregnant women, seniors (even on Medicare), caregivers and disabled persons, to name a few demographic groups, if they meet eligibility requirements.

In October of this year, a letter was mailed out informing affected Medicaid users of the upcoming changes, and the need to enroll in a MCO (either SilverSummit or CareSource) by December 26 or they would be assigned an MCO. Another letter was mailed this December letting recipients know their assigned MCO if they didn’t already enroll, and that a grace period to switch providers if they want would extend from December 26 to March 31, 2026.

Unfortunately, not all rural Medicaid users received these letters, which could result in a gap in benefits, or worse, loss of some or all of their services.

“I’m going to tell you, a note to somebody that’s homeless out in the rural areas,” explains Kim Riggs. “We’ll never get to them. Most of the individuals that are homeless use addresses that they’ll never, ever see their information.”

Riggs, who currently is with Company Xceleration (a consulting company), has decades of health care, including Medicaid experience in her various leadership positions with the state, and is passionate about helping underserved and vulnerable populations. MCOs work well in an urban setting, where the choice of medical providers within the MCO’s network is plentiful, and Medicaid recipients have a variety to choose from.

Riggs mentions her concerns, “We really need to put an emphasis on getting out there and telling individuals where there are no services that there’s going to be a change in the MCOs out there. Most of those people in the rural areas have no clue what managed care organizations are.”

So, Riggs organized the MCOs (CareSource and Silver Summit), state agencies, community partners and emergency response professionals to educate and support the small town of Dyer, population 324. Eighty residents attended the event in early November, with 36 of those on Medicaid. The residents that attended were also given information on mental health and suicide prevention, free legal advice and much more.

With time running out, and roughly 100-plus rural and ‘frontier” towns, Riggs’ grassroots community education events can’t reach all the people that need information on the changes to Medicaid. In Pahrump, just under 9,000 residents are currently on Medicaid.

For more information on the available managed care organizations providing Medicaid options, visit their websites or call the numbers listed below:

Silver Summit - (775) 567-5744 or https://www.silversummithealthplan.com/

CareSource - (833) 230-2112 or https://www.caresource.com/nv/providers/welcome/medicaid

John Clausen is a freelance photographer and reporter.