Welcome Nevada Medicaid Members

Follow Nevada Medicaid at:

• Facebook.com/NVHealthandHumanServices
• Twitter.com/DHHSNevada

Contact your the Division of Welfare and supportive services by email or at a DWSS office if any of these things happen:

• Change in income
• Status as a resident changes
• Get other insurance coverage
• Get additional assets
• Get married
• You Move
• A family member dies
• You get pregnant or have a baby
• A child is emancipated (legally becomes an independent adult)
• You become an inmate of a public institution or ward of the state

Please answer all requests for additional information right away, so that you don’t lose coverage. If you don’t follow Medicaid or NCU rules, or are not truthful on your application, you could lose your Medicaid/NCU coverage and may have to repay your medical costs.

You probably won’t have to make any payments if you follow the rules. Here are some examples of when you do have to pay:

• Quarterly premiums if your child is on Nevada Check Up (NCU);
• If you get care from someone who is not an approved Medicaid or NCU provider;
• If you or a family member are not covered by Medicaid or NCU;
• If you ask for and get services that are above the Medicaid or NCU service limits.
• If you are a non-citizen who has Emergency Medicaid Only (EMO) coverage and any dates of services and/or procedures are deemed to not meet the EMO criteria you may be financially responsible and billed by the provider for those non-covered days/procedures.

Talk to your health care provider about any problems you have with your medical bills.

• When you schedule your appointment, make sure your health care provider accepts Medicaid or NCU.
• If you need help getting to your appointment, call the non-emergency medical transportation company (see Transportation Services in the Benefits section). Make plans at least five days before your appointment.
• Tell your provider if you have any other type of health care coverage.
• Make sure the service you receive is covered by Medicaid or NCU. See the “What Is Prior Authorization?” below.
• Show the health care provider your Medicaid/NCU Card each time you get medical treatment.

Medicaid and NCU cover many medical supplies that are ordered by your doctor for a medical reason. For example, some supplies which may be covered are:

• Incontinent supplies (adult diapers) · Wheelchair, canes, crutches and walkers
• Prosthetic orthotic devices · Wound care supplies
• Oxygen and Supplies

Talk to your doctor if you need medical supplies. Your doctor may write a prescription for you to take to a medical supply company. The medical supplier must get prior approval from Medicaid and NCU for some items.

Healthy Kids, also known as EPSDT, is a special benefit for children on Medicaid/NCU. Some problems start before your child looks or feels sick. Your doctor can find and treat these problems early, before they become serious, with regular “well-child” exams. Healthy Kids/EPSDT also covers dental, vision and hearing check-ups. Healthy Kids/ EPSDT services are available to most recipients from birth to under age 21 years old. These services include:

• Well-child exams by your child’s doctor. This is a head-to-toe exam including health history, eating habits, vision and hearing exams, mental health evaluation and a growth and development check;
• Vaccines to keep your child healthy;
• Dental checkups, including a complete exam and cleaning twice a year, or more often if your child’s dentist recommends it;
• Fluoride treatment and sealants;
• Follow-up treatment and care if a health problem is found during an exam;
• Lead testing and other laboratory tests; and
• If needed, free transportation to any Medicaid-approved medical appointments (does not apply to NCU recipients).
• When should your child have a well-child exam?
• Newborns – as soon as possible after birth
• Infants – at one, two, four, six, nine and 12, 15, 18, 24, and 30 months
• Toddlers to young adults (3 and under 21 years old) every year

Laboratory and radiology services are covered; they may be done in your doctor’s office, or your doctor may refer you to another clinic, laboratory, or hospital.

If you think you are pregnant, see a provider as soon as possible. Early maternity care will help you give birth to a healthy baby. You may choose to see a specialist such as an Obstetrical/Gynecological (OB/GYN) Physician, Advanced Practice Registered Nurse (APRN), Physician’s Assistant (PA), or a Nurse Midwife (NM). Medicaid covers vaginal births and medically necessary caesarian-sections. Covered services include:

• Prenatal visits, laboratory work, and necessary tests (such as ultrasound)
• Labor and delivery
• Doula services
• Anesthesia (pain treatment)
• The hospital stay
• Home births
• Freestanding birthing centers
• Postpartum visits
• Birth control/family planning

These are benefits you may receive to treat an acute (short-term) or chronic (continuing for a long time) behavioral health disorder. Some of these services include:
Inpatient services:

• Acute hospital inpatient psychiatric services which may include inpatient alcohol/substance use detoxification services
• Residential Treatment Center (RTC)/Psychiatric Residential Treatment Facility (PRTF) Services
• Residential Treatment for substance use disorders

• Targeted Case Management
• Psychiatric Evaluation
• Medication Management
• Psychological and Neuropsychological Testing
• Screening and Comprehensive Behavioral Health Assessment
• Psychotherapy services
• Partial Hospitalization Program (PHP)
• Intensive Outpatient Program (IOP)
• Basic Skills Training (BST)
• Psychosocial Rehabilitation (PSR)
• Peer-to-Peer Support
• Day Treatment
• Crisis Intervention
• Outpatient Alcohol and Substance Use Services including but not limited to:
  • Medication Assisted Treatment
  • Outpatient Substance Use Treatment services
• Services delivered through a Certified Community Behavioral Health Center
• Applied Behavioral Analysis for individuals under 21 with a diagnosis of Autism or Fetal Alcohol Syndrome
• Services for Youth Eligible for Specialized Foster Care
  • Intensive In-Home Supports and Services
  • Crisis Stabilization Services

The Personal Care Services program helps people with disabilities or long-lasting illnesses live independently in their home. These services are for people who do not have someone legally responsible to help them. A Personal Care Attendant (PCA) helps people with tasks like bathing, dressing and toileting, and may also help with meal preparation, shopping for essential things like food, laundry and light housekeeping. The type of service and number of hours allowed are based on medical need. A physical or occupational therapist will do an evaluation. If you think you have a medical need for personal care services, contact Medicaid at (800) 525-2395.

SHS are medical services provided by a Local Education Agency (LEA) or State Education Agency (SEA) for children who attend public schools in Nevada. SHS are available for enrolled Medicaid and Nevada Check Up (NCU) students between 3 years of age and under the age of 21 years old, in both Fee-for-Service (FFS) and Managed Care. The services are covered under FFS and not billed to the Managed Care entity.
Nevada Medicaid may pay for some medically necessary health-related services provided by the schools when the services are written in your child’s Plan of Care (POC), Individualized Education Program (IEP), 504 Plan or for those services available under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit .
The schools are required to obtain your consent before releasing your student’s information for billing Medicaid under the SHS. This is completed with a consent form.
To receive services under SHS, there are responsibilities that parents need to follow, such as:

• Providing the school district with accurate and current medical information, including diagnosis, attending physician, medication, etc.
• Assuring that your child sees a doctor for their annual “well-check” check-up.
• Providing your child’s Medicaid or NCU ID number and any other insurance information.
• Providing the school with your decision on the consent form to bill Medicaid.
• Understanding that consent is voluntary and can be revoked at any time.
• Attending all POC, 504 Plan and IEP development meeting(s) to fully understand your child’s services.

 If you have serious speech or hearing problems, see your doctor. Your doctor may refer you to a speech therapist or an audiologist. Some services covered by Medicaid or NCU are:

• Hearing tests
• Hearing aids
• Hearing aid batteries
• Speech therapy

If you are elderly or have a physical or intellectual/developmental disability and meet the level of care for a long-term care facility, Medicaid may be able to pay for support and services enable you to live safely in your own home or community rather than in a nursing facility or other institution. Some of the waiver services include:

• Adult Day Care
• Attendant Care
• Augmented Personal Care in group homes
• Chore
• Emergency Response Systems
• Homemaker Services
• Home-delivered meals
• Respite care for family members who need a break from caring for disabled or elderly family members
  
  There is a set number of people who can be on these pro- grams. For information about how to apply for one of the waiver programs, call the Aging and Disability Services Division (ADSD) District Office in your area or go to adsd.nv.gov.