Nevada Transitions Rural Medicaid to Managed Care Organizations

Nevada is transitioning Medicaid recipients in 15 rural counties from a fee-for-service (FFS) model to managed care organizations (MCOs). This change aligns rural Medicaid programs with practices long established in urban areas like Washoe and Clark counties where MCOs have been in place since the late 1990s. Approximately 70,000 rural Medicaid users must enroll in one of two MCOs, SilverSummit or CareSource, by December 26, 2025, or they will be auto-assigned. A grace period for switching MCOs runs through March 31, 2026. However, some rural recipients did not receive notification letters, risking gaps or loss of benefits during the transition. Medicaid, a joint federal-state health insurance program, supports a diverse population including children, pregnant women, seniors, and disabled individuals. The move to managed care aims to provide coordinated care through provider networks typical of MCOs. While MCOs are effective in urban settings with extensive provider choices, challenges persist in rural areas where healthcare resources are limited and awareness of managed care models is low. Outreach efforts are underway to educate rural communities about the transition. Kim Riggs, a healthcare consultant with extensive Medicaid experience, has organized community events combining Medicaid information with broader health and legal support services. For example, a session in the town of Dyer engaged 80 residents with focused education on Medicaid changes alongside mental health and legal resources. Despite these efforts, reaching all individuals in around 100 rural towns remains difficult, exacerbated by factors such as homelessness which impedes communication. Medicaid recipients in rural Nevada are encouraged to contact MCO providers directly to ensure enrollment and access to benefits. The transition represents a significant operational change for providers, recipients, and state administrators. It underscores the ongoing need to address rural healthcare disparities and enhance communication strategies during policy shifts. Stakeholders should monitor enrollment data, beneficiary outcomes, and provider network adequacy as the statewide rollout proceeds.