Managed Care


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.


Effective July 1, 2017, the Division of Health Care Financing and Policy (DHCFP) will offer three (3) Managed Care Organizations (MCOs) for Medicaid Managed Care recipients, which include the following vendors: Better Amerigroup Community Care (AGP), Health Plan of Nevada (HPN) and SilverSummit Healthplan (SSH).    

Beginning 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. 

Effective 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. 

 

Last Edited: 7/25/2017