Nevada Medicaid


The Medicaid health insurance program in Nevada is open to various residents who have a low income and fall into the groups of children, parents, aged, blind, disabled, pregnant — and under the Affordable Care Act, adults without children. Depending on a person’s income and which category they fit into, the program will provide a comprehensive health plan at no cost. Children and pregnant women are grouped into one category, and children can make use of the Healthy Kids program with their Medicaid coverage. Pregnant women will have access to medical care through the duration of their pregnancy and delivery, as well as post-natal office visits.

Those who receive Supplemental Security Income (SSI) are automatically eligible and enrolled in Medicaid, thus covering the aged, blind and disabled group of members. Medicaid for Low-Income Adults covers unemployed and working parents in Nevada who have children living in their home with a very low income. Medicare beneficiaries with income at or below the Federal Poverty Level or slightly above can also receive assistance with their Medicare payments through Medicaid.

The program offers a variety of benefits to help individuals get the care they need, whether for regular health care services or special needs. Children and adults with physical or mental health conditions or disabilities are welcome to any treatment necessary through Medicaid. All members, regardless of their health, have access to a number of services from preventive care to inpatient and outpatient hospital services, as well as prescriptions and supplies. Nevada Medicaid is a great source of coverage for those who are unable to afford another.

 

Nevada Medicaid Eligibility

In order to qualify for Medicaid, you must meet the requirements of being a Nevada resident, and a U.S. citizen or legal immigrant. You must also not have access to any other type of insurance, such as employer-sponsored benefits, COBRA, or be enrolled in a short-term plan. It is also necessary to meet the state’s income guidelines to find out if you are eligible. Each group has a different income limit, which is a percentage of the current Federal Poverty Level (FPL). As long as your income does not exceed this amount, you should be able to receive Medicaid benefits.

Under the federal health law, adults are able to receive full Medicaid benefits if they earn up to 138 percent of poverty.

Individuals and Families

Adults without children 138%

Pregnant Women & Infants 133%

Children age 1-5 133%

Children age 6-19  100%

Parents 138%

 

Social Security Beneficiaries

Single Aged 86%

Single Blind 87%

Single Disabled 75%

Couple Aged 89%

Couple Blind 114%

Couple Disabled 83%

 

Medicare-Medicaid Dual Eligibles

Qualified Medicare Beneficiaries (QMB) 100%

Medicaid covers your premiums, coinsurance, and deductibles.

 

Specified Low-Income Medicare Beneficiaries (SLMB) 120%

Medicaid covers your premiums only.

 

Covered Benefits

  • Ambulance services and other medical transportation
  • Physician services
  • Dental care
  • Laboratory and X-ray
  • Rehabilitative services
  • Prescription medication
  • Mental health care
  • Hearing care
  • Vision care
  • Medical supplies
  • Durable Medical Equipment
  • Chiropractic
  • Outpatient surgery
  • Hospitalization
  • Nursing facilities
  • Home health care
  • Prosthetics
  • Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
  • Podiatry
  • Physical, occupational, and speech therapy
  • Respiratory therapy
  • Rural health clinics
  • Psychologist services
  • Case management

 

Providers & Managed Care

The Medicaid program is administered through several managed care organizations throughout the state, which you can select based on availability in your area. There are only two health insurance companies offering Medicaid coverage at the moment, and these are Amerigroup and Health Plan of Nevada. Doctors and facilities approved through the provider networks of these organizations as well as traditional fee-for-service provider networks.

 

How to Apply

To apply for Medicaid, or any other medical program offered through the state of Nevada, use the Nevada Department of Health & Human Services ACCESS online application portal. Applications are available in both English and Spanish translations, and this site also gives you access to applications to determine your eligibility for TANF (Temporary Assistance for Needy Families) and SNAP (Supplemental Nutrition Assistance Program).

ACCESS Nevada

 

Resources

Nevada Department of Health & Human Services

DHHS Department of Welfare & Supportive Services

Contact the DHHS Medicaid Division

1100 East William Street, Ste 100

Carson City, NV 89701

(775) 684-3676