Medicaid is a medical coverage program that’s available to low income individuals as an invaluable resource for Nevada residents.
If you qualify for Medicaid in Nevada, it’s vital that you fully understand the benefits that are available to you through this healthcare program.
Medicaid covers expenses in a variety of categories from emergency care to family planning, dentistry, and even optometry for all ages. In this article, we talk in depth about what it takes to qualify for Medicaid as well as all the benefits that beneficiaries can receive.
Who qualifies for Medicaid in Nevada?
To qualify for Medicaid in Nevada, you must fulfill certain requirements. You must be a resident of the state as well as a U.S. citizen, a U.S. national, a permanent resident, or a legal alien who is in need of healthcare and assistance with insurance.
You must be in a financial situation that would be categorized either as low income or very low income according to Nevada law. And you must also meet one of the following criteria:
● You must be pregnant.
● You must be blind.
● You must be responsible for taking care of a child under 18 years of age.
● You must be 65 years of age or older.
● You must have a disability.
● You must have a family member with a disability who lives with you in your household.
Annual income limits must be below certain amounts that depend on household size. In Nevada, the qualifying amount is equivalent to 138% of the federal poverty level. For 1 person households in 2020, the maximum annual income level to qualify for Medicaid is $16,753 or $34,639 for a family with four members. With each additional household member, the maximum income level goes up.
If you qualify for Medicaid, there is no limit on the enrollment period. In other words, you can enroll for this healthcare program at any time. Visit Access Nevada to find out if you’re eligible for the program and to check on the status of your case. Through this online portal you can manage your account and receive online communications.
What does Medicaid cover in Nevada?
In the case of an emergency, all Medicaid recipients are entitled to receive coverage for both air and ground ambulance transportation services. You only need to call 911 to receive emergency transport, and you will be covered as long as you contact Medicaid and/or your doctor after the ride to ensure that it will be covered.
Birth Control/Family Planning
You may receive coverage of family planning services as a Medicaid recipient from any provider in the network. A referral is not required if you plan to go to a qualifying specialist as long as the specialist accepts both Medicaid and NCU. The following forms of birth control are covered:
● Birth control pills
● Shots (such as Depo-Provera)
Dental coverage varies depending on whether the recipient is an adult, child, or a pregnant woman. Adults receive coverage of emergency dental care, palliative care, and certain prosthetic procedures and services, while adult pregnant women may receive certain extra benefits. Adults qualify to receive coverage of these services as long as they receive only Medicaid coverage and not also NCU. Children (under age 21) receive full coverage of all dental services, including some orthodontic services.
In some cases, qualifying dentists may need to receive approval from Medicaid or NCU to provide covered care of certain services and procedures.
Disposable Medical Supplies, Durable Medical Equipment, and Orthotics and Prosthetics
Medical supplies that are ordered by your doctor for the care of a medical situation may be covered by Medicaid under certain circumstances. Some medical supply providers may need to contact Medicaid to receive approval for the coverage of certain items. In order to receive coverage for any medical supplies, you must first receive a prescription from your doctor for the supplies, which you may then take to the medical supplier where they can receive approval for the coverage of the item. Some items that may be covered include:
● Wound care supplies (bandages, etc.)
● Insulin pumps
● Prosthetic orthotic devices
● Wheelchairs, canes, crutches, walkers, and other mobility devices
● Incontinence care supplies (adult diapers, etc.)
Doctor visits or trips to an Urgent Care Clinic are covered by Medicaid when you are having health issues. Your doctor may refer you to an in-network specialist at the time of the visit. Regular check-ups are important to maintain an updated medical history.
In the case of an emergency, call 911 to receive emergency transport or go directly to the emergency room of the nearest hospital. When you have recovered enough and there is no longer an emergency, contact your doctor immediately so that you may receive coverage for the emergency medical care. If care is needed following the emergency, your doctor must be the one to provide it.
For any non-emergency medical events where it is not possible to go to your primary medical provider, you must go to an urgent care clinic.
Eye Exams and Eyeglasses
Nevada Medicaid covers the following eye-related medical services:
● Eye disease care
● Medically necessary eye surgery
● Eye exams
● Cost of prescription eyeglasses
It is important to note that an eye exam and the cost of new prescription eyeglasses are only covered by Medicaid once every 12 months. Only one new set of eyeglasses (and the corresponding exam) may be covered during any year-long period. For the cost of the frames, your eye doctor will indicate which frames you may purchase that are completely covered by Medicaid. If you choose to have frames that are not completely covered, you will be required to pay the difference and sign an agreement before paying for the frames.
Prescription contact lenses are not covered unless they are deemed medically necessary.
Healthy Kids/Early Periodic Screening Diagnosis and Treatment (EPSDT) or Preventative Health Services for Children
The Healthy Kids (aka EPSDT) benefit is available specifically for children on Medicaid and/or NCU. Individuals under the age of 21 who qualify for Medicaid may receive this benefit in the vast majority of cases. This particular benefit covers the following services:
● Well-child exams (must be done by the child’s primary care provider). A well-child exam includes a complete check-up as well as an analysis of the child’s eating habits, vision and hearing, mental health, and their growth and development.
● Dental check-ups (two check-ups per year are covered by Medicaid, and each check-up includes a full dental cleaning and exam)
● Fluoride dental treatments and dental sealants
● Lead testing and other laboratory tests
● Transportation costs for transport to any Medicaid-approved medical appointment (NCU recipients do not receive coverage of non-emergency transport)
● Follow-up testing and treatment if any medical issues are found during any check-ups
Newborn babies typically receive a hearing test during their initial hospital stay and childhood hearing tests are included with Healthy Kids/EPSDT exams. Hearing tests for both adults and children are also covered if they’ve been deemed medically necessary by your physician.
Home Based Habilitation Services (HBHS)
These services are provided specifically to individuals with ongoing mental health conditions and/or illnesses that affect their ability to live on their own. HBHS services may include:
● Private-duty nursing
● Home health care
● Partial hospitalization (when necessary)
● Adult day health care
● Personal care services
Keep in mind that if you believe that you or a loved one requires this Medicaid benefit, you will need to consent to a medical evaluation. This evaluation will ensure that you or your loved one meets the eligibility requirements to receive these services, and it also ensures that you will receive the highest quality of care possible.
Home Health Care
Home health care is designed to support elderly individuals who need extra help or to help people who are physically or mentally compromised in some way. Home health care provides quality medical care at home. Services include:
● Skilled nursing care at home
● Physical therapy
● Occupational therapy
● Speech therapy
If you believe you qualify for this benefit, talk to your doctor. If your doctor determines that you are eligible, they will contact a Medicaid-approved home health agency, which will then submit a request for approval to Medicaid on your behalf.
Hospice care is designed to provide support for someone near death. Family members and the individual who has reached the end of their life may receive additional support services covered by Medicaid. These services include support of physical, emotional, and spiritual needs provided in a designated facility, such as a hospice facility, nursing facility, Intermediate Care Facility (ICF), or at your home. Different specialists are available to provide support for all connected individuals during the final stages of life.
Hospital care is covered by Medicaid as long as you have received a referral by your doctor. Both in-patient and out-patient services are covered.
Under Medicaid, all medically recommended vaccinations for adults and children are completely covered. Vaccinations that are included may be:
● Hepatitis B
● Diphtheria, tetanus, and whooping cough (DTaP)
● Haemophilus Influenza type B
● Seasonal Influenza (yearly for adults and children)
● Measles, mumps, and rubella
● Hepatitis A
● Zoster vaccine (for older adults)
Lab and Radiology Services
Laboratory and radiology services may be done by your doctor at the doctor’s office, or they may be done at a clinic, hospital, or another office if your doctor refers you somewhere else. All X-ray and laboratory testing services are covered by Medicaid.
Maternity care services are covered by Medicaid as long as you choose to visit an OB/GYN or certified nurse midwife who is in the network and will accept Medicaid coverage. Visit a doctor or specialist as soon as you believe you are pregnant so that you may receive high quality care throughout your pregnancy, increasing your chances of giving birth to a healthy baby. Medicaid covers the following maternity care services (among others):
● Birth control/family planning pre-pregnancy
● Prenatal visits, including necessary lab work and tests (like ultrasounds)
● Hospital stay after birth (stays of up to 72 hours after a normal birth and of up to 96 hours after a C-section birth are covered)
● Labor and delivery
● Anesthesia (pain treatment/management) during birth
● The second- and/or sixth-week check-up after birth
● C-sections deemed medically necessary (C-section births that are done for the convenience of the mother or doctor are not covered by Medicaid)
New mothers covered by Medicaid may register their babies under Medicaid before leaving the hospital in order to receive one year of Medicaid for the new baby. Contact your DWSS caseworker as soon as possible after the birth of your baby to secure Medicaid for them after birth. You may register your baby for NCU services as long as you notify DWSS within 14 days after the baby’s birth. The baby may keep Medicaid and/or NCU coverage so long as the parent meets the eligibility requirements the following year(s).
Mental Health/Substance Abuse Services
Both acute and chronic behavioral disorders are covered by Medicaid including:
● Psychiatric evaluations
● Inpatient services
● Outpatient services
● Medication management
● Alcohol/substance abuse detoxification
● Nursing home services for cognitive or behavioral impairments
If you are pregnant, you may choose to hire a midwife during your pregnancy. To get coverage for a midwife, you must choose one that is certified or licensed and who accepts Medicaid.
Nursing Home Services
Nursing home facility care that provide 24 hour services may be covered when your health problems or injuries simply cannot be handled at home. Cognitive impairments and behavioral impairments may require the services of a qualified nursing facility. Even out-of-state nursing facility coverage may be offered to Nevada residents if a Nevada nursing facility can’t provide the appropriate type or level of care or if you live at or near a state border and it is more practical for you to receive out-of-state care for that reason.
Occupational Therapy Services
Occupational therapy is provided to help you learn or relearn tasks after a serious injury, disability, or illness. You must receive a doctor’s order for occupational therapy to receive Medicaid benefits for this service.
Over-the-Counter Drugs with a Prescription
With a doctor’s prescription, you can get coverage for over-the-counter medications such as aspirin, acetaminophen, antacids, and cold medicines for symptom relief from respiratory illness or allergies. Take your doctor’s prescription to the pharmacy and Nevada Medicaid will cover it.
Personal Care Services
The Personal Care Services program is a service that was developed to help people with long-lasting illness or disability to live in their home independently. Personal Care Services are for individuals who don’t have anyone who is legally responsible for them. A Personal Care Attendant is assigned to assist you in your home with things like light housekeeping, food preparation, or laundry. An occupational or physical therapist will evaluate you to determine your medical need in terms of the type of personal care that you need and the number of hours the Personal Care Attendant will be available to you.
Physical Therapy Services
Physical therapy is covered by Medicaid if you suffered a serious illness or disability and you need this type of treatment to improve your condition. Your doctor must order it and authorize a physical therapist who also accepts Medicaid.
The Healthy Kids preventative screening program known as Early Periodic Screening Diagnosis and Treatment (EPSDT) covers well-child exams that help to detect health problems early, before they become serious. This program also includes dental checkups. It covers children from birth through age 20.
Private Duty Nursing
Visiting nurses can provide you with individualized and ongoing care that allows you to stay in your home rather than going to a nursing facility. In order to receive reimbursement from Medicaid, you must have a doctor’s order to receive coverage for this service.
Many prescription drugs are covered by Medicaid, though some prescriptions do require prior authorization. Your doctor has a list of Medicaid-preferred drugs from which to choose. Prescription drugs that are not covered by Medicare will likely be covered by Medicaid including certain over-the-counter medications. Prescription drugs for cosmetic, experimental, or weight loss reasons are not covered by Medicaid.
Smoking Cessation Products
Medicaid in Nevada supports your efforts to stop using tobacco. Get a prescription from your doctor for prescription medications to stop smoking or to purchase over-the-counter medications like patches or lozenges. Medicaid will reimburse prescription, over-the-counter medications, or even smoking or tobacco cessation counseling from a qualified individual.
If your general practitioner deems that it is medically necessary for you to receive care from a specialist, Medicaid in Nevada may pay for this specialty care.
Speech and Hearing Services
Some speech and audiology services are covered by Medicaid in the state of Nevada. Visit your doctor if you have serious problems hearing or speech. Your doctor may give you a referral to see an audiologist or a speech therapist. Some of the services that are covered by Medicaid in Nevada include:
● Hearing tests
● Hearing aids
● Speech therapy
● Hearing aid battery replacement
Non-emergency transportation (including different forms of transport to and from medical appointments) is covered by Nevada Medicaid on a conditional basis. In order to receive coverage for non-emergency transport (NET), the following requirements must be met:
● The transportation is arranged by a company that has contracted with Medicaid.
● The ride will be to a Medicaid-covered medical appointment.
● The ride must be arranged 5 days in advance (or more).
● In the case of an urgent care ride where prior arrangement is not possible, the transportation company may provide you with a ride on the same day that you call so long as they have contracted with Medicaid.
Keep in mind that if your doctor’s appointment is cancelled and you no longer need transportation, you must cancel your ride as soon as possible. Public or private NET is available to Medicaid recipients, although NCU recipients may not receive coverage for non-emergency transportation.
Waiver Program Services
Waiver programs make it possible for Medicaid to pay for certain support services that would allow you to continue living in your own home or community rather than going to a skilled nursing facility or other type of institutional setting. Contact your Medicaid District Office for more information about who can access these programs.
Waiver services include the following:
● Homemaker services
● Group homes
● Emergency response systems
● Adult day care
● Day treatment centers
● Home-delivered meals
● Family support services
● Respite care for family members in need of time off from caring for elderly or disable family members
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