May 24, 2023 – In a groundbreaking move, lawmakers in Nevada have given the green light to a project that is set to shake up the healthcare landscape in the state – a statewide Medicaid managed care organization program. This could be a big win for healthcare services across the state.

As of mid-May, members of the joint budget subcommittee recommended the Legislature approve $3.8 million of funding over the next two years to prepare for the implementation of the managed care organization program starting in the summer of 2023. The program is expected to go live by January 2026.

In essence, this program focuses on providing coordinated care to Medicaid beneficiaries across the state to help improve the quality of services patients receive. In the past, managed care services were not available in rural areas of Nevada. That is going to change.  With this new program, the entire state will be covered, which could add approximately 70,000 to 80,000 individuals to the program.

Some challenges need to be tackled, like ensuring the program is implemented in a way that genuinely meets the needs of patients across the state. Rural providers have expressed some concern that what they’re being paid will be affected, but Nevada Medicaid Administrator Stacie Weeks said the move to statewide managed care should not negatively affect rural providers. That is because state law requires Nevada Medicaid to implement a rate floor for rural providers through what is called a state-directed payment.

“In effect, this would mean that these rural providers should not be paid any less by managed care plans than what they are paid today by Medicaid fee-for-service,” Weeks wrote in an email to The Nevada Independent. “The Division may expand this floor to other rural providers pending feedback from a request for information that the Division intends to release this summer.”

This request for information will be key as the intent is to gather public and stakeholder input to ensure that the statewide expanded managed care model works for everyone. 

So, what happens next? The program will kick off with a planning phase, during which the state will have to work out the details of implementing managed care on a statewide basis. It’s a bold move that could be a game-changer for Medicaid services in Nevada.