The mission of the Managed Care Unit is to provide the best quality managed health care possible for Medicaid participants. In order to succeed, the Managed Care Unit staff must work closely with licensed managed care organizations (MCOs) to develop plans of service which will meet the needs of Nevada's TANF and CHAP populations. We must also maintain close working relations with the Welfare and Supportive Services Division and its district offices to ensure Medicaid managed care participants receive the most current, accurate information regarding managed care services available to them.
July 1, 2017, the Division of Health Care Financing and Policy (DHCFP) will
offer four (4) Managed Care Organizations (MCOs) for Medicaid Managed Care
recipients, which include the following vendors: Aetna Better Health of Nevada
(AET), Amerigroup Community Care (AGP), Health Plan of Nevada (HPN) and
SilverSummit Healthplan (SSH).
this year (2017) and going forward, Open Enrollment will run from April 1
through June 30, with lock in effective July 1. Any household requesting a
change during Open Enrollment may make one final change to another MCO within
90 days from July 1, 2017.
One Open Enrollment letter is mailed per
managed care household for recipients currently enrolled in an MCO. Any
recipient requesting to change their MCO choice after the close of Open
Enrollment must contact their current MCO to request a “Good Cause” for
disenrollment. Any household requesting a change during Open Enrollment may
make one final change to another MCO within 90 days from July 1, 2017.
July 1, 2017, all dental services will be provided through Fee-for-Service
until a Dental Benefits Administrator (DBA) contract is awarded. The DHCFP is
currently in the procurement process for selection of a single DBA vendor to
serve recipients included in the mandatory MCO coverage areas of urban Washoe
and urban Clark counties.
Actuarial Services by Millimam, Inc.