What is Nevada Medicaid and Nevada Check Up?
Nevada Medicaid
is a program that provides quality health care services to low-income
Nevadans who qualify for services based on federal and state law. Nevada Medicaid
does not reimburse an individual; rather it sends payments directly to
the health care providers.
Select the following to find out more about Nevada's Medicaid and Check Up
Services
Nevada Medicaid
is often confused with Medicare. The basic difference is that
eligibility for Nevada Medicaid is based on financial need. Medicare is
not based on financial need but is available to almost anyone who has
been determined disabled by the federal Social Security Administration
or who is age 65 years of age or older. For more information on
Medicare, please call the Social Security Administration Helpline toll
free at 1-800-772-1213.
Nevada Check Up
is a program designed for families who do not qualify for Medicaid and
whose incomes are at or below 200% of the federal poverty level (FFP).
Participants in the Nevada Check Up program are charged a premium based
on income.
Who is Eligible for
Nevada Medicaid
and NevadaCheck Up?
To be eligible
for Nevada Medicaid you must qualify for an eligibility category.
Generally, the categories of eligibility are children, pregnant women,
families with dependent children, disabled adults, or persons age 65 or
older.
You must be
financially eligible for the Nevada Medicaid program. The rules for
assessing your income and assets vary from category to category and are
complex. Your Welfare Division caseworker will work with you to evaluate
your financial eligibility and the programs that may be available to
you. There are special rules for those who live in nursing homes and for
disabled children living at home.
To be eligible for Nevada
Check Up you must be 18 years of age or younger. Eligibility is based on
the income of household members. There are special rules for those who
live in nursing homes and for disabled children living at home. If you
are eligible for Nevada Medicaid, you can not be eligible for Nevada
Check Up.
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How do Nevada Medicaid and
Nevada Check Up work?
When your Nevada Medicaid or Nevada Check Up eligibility is
determined, you will receive, monthly, a Nevada Medicaid card.
Each family member who is determined eligible will receive their own
individual card. You must show your Nevada Medicaid or Nevada Check Up
card to your doctor or the health care provider each time you receive
medical treatment. Your provider will send the bill directly to
Nevada Medicaid for payment. Nevada Medicaid pays for Nevada Check Up
health benefits. For some services, Nevada Medicaid may require you to
share the cost. Most Nevada Medicaid or Nevada Check Up recipients will
be enrolled in Managed Care and may receive services through an HMO. HMO
members will receive additional information about how to access
services.
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What if I have medical
insurance or health coverage?
Generally, Nevada Medicaid is the �payer of last resort.� This
means that if you have other health insurance or belong to other
programs that can pay a portion of your medical bill, payment will be
collected from them first. Nevada Medicaid may then pay all or part of
the amount that is remaining.
This
is very important:
When you apply for Nevada Medicaid or Nevada Check Up you
MUST
indicate if you have any other type of health care insurance or
benefits. Your caseworker can help you determine if you have any other
type of health care coverage.
|
Other sources of health care coverage include,
but are not limited to |
|
Private
Health Insurance |
Public
Employees Benefits Program |
|
Medicare |
Worker�s Compensation |
|
Medical
support from absent parents |
TRICARE
(CHAMPUS) |
|
Court
judgments or liability settlements for accidents or injuries |
Veterans Administration (VA) benefits |
|
Long-term care insurance |
|
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What Health Services Does
Nevada Medicaid and Check Up Cover?
We want you to find out
more about the benefits covered by Nevada Medicaid, The next section
will give you details about benefits.
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Ambulance/Transportation
When seconds count call 911 for an ambulance. Nevada Medicaid and Nevada Check Up cover ambulance services in an emergency with contracted providers.
Air ambulance is covered when ground ambulance can not get you medical
care fast enough.
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Family Planning
Talk to your doctor or clinic about family planning. You may
receive family planning services from any provider who accepts Nevada
Medicaid or Nevada Check Up. You do not need a referral. You may receive
some types of birth control in your doctor�s office. For others, your
doctor will write a prescription. The following forms of birth control
are covered by Nevada Medicaid and Nevada Check Up:
|
Birth Control Pills |
Foams |
|
Creams |
Sponges |
|
Diaphragms |
IUD�s Norplant |
|
Shots (Depo-Provera) |
Condoms |
Nevada Medicaid and Nevada
Check Up pay for a woman to get her
tubes tied or a man to have a vasectomy (sterilization). Nevada Medicaid
and Nevada Check Up do not pay to reverse the surgeries. You must be 21
years of age or older. And both you and your doctor must sign a
�consent� form 30 full days before the surgery.
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Healthy Kids, Early and
Periodic Screening Diagnosis and Treatment (EPSDT)
Healthy Kids or EPSDT is a special benefit offered by Nevada Medicaid. The objective of this program is to keep children
healthy. EPSDT covers medical checkups for children. Well child exams
include vision and hearing screenings. EPSDT also covers dental
checkups. Almost anyone from birth to age 20 who received Nevada
Medicaid can receive EPSDT covered services.
Regular checkups help keep your children healthy. Some problems
start before your child looks or feels sick. Your doctor can find and
treat these problems early, before they lead to a serious problem.
EPSDT Services include:
|
Well child exams by your child�s doctor. A head-to-toe exam
that includes health history, eating habits, eyesight and
hearing exams, and growth and development check. |
|
Shots (immunizations) to keep your child healthy. |
|
Dental checkups by your child�s dentist. A complete exam and
cleaning twice a year. Fluoride treatment and sealants are
covered for children. |
|
Follow up treatment and care of a health problems which are found
during an exam. |
|
Children may receive benefits that are usually not covered by
Nevada Medicaid or Nevada Check Up. |
If you missed an appointment for one of these services, take your child in as soon
as possible. Make sure you ask for an EPSDT exam and tell you doctor if
you have Nevada Medicaid coverage. Remember to take
your child�s shot record with you.
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When should my child have an EPSDT checkup?
|
Newborns - as soon as possible after birth |
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Babies-ages 1, 2, 4, 6, 9, 12, 15, 18, and 24 months. Shots are due
at many of these sites. |
|
Toddlers-ages- 3, 4, and 5. More shots are due at some of these
visits. |
|
Children-ages 6, 8, 10 and 12 years old |
|
Teenagers and young adults-ages 14, 16, 18 and 20. |
If you missed an appointment for one of these services, take your child in as
soon as possible.
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Dental Benefits
Use a dentist who accepts Nevada Medicaid or Nevada Check Up.
Dental benefits that Nevada Medicaid covers include:
|
Adults; emergency only |
|
Children: full coverage |
Your dentist needs prior approval from Nevada Medicaid or Nevada
Check Up for some of the benefits.
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Doctor Visits
Nevada Medicaid and Nevada Check Up pay for your children to see
the doctor or visit an urgent Care Clinic when you are having health
problems. Most of the time you can get the treatment you need from your
primary care doctor. If needed, your doctor may refer you to a
specialist.
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Emergency Room
Use the emergency room when you have a serious medical problem
that cannot wait. Waiting could mean permanent harm or death. In an
emergency call 911 or go to the emergency room right away. You do not
have to call your doctor first. You will need to call you doctor when
the emergency visit is over. Your doctor must provide any follow up care
needed after the emergency.
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Eye exams and Eyeglasses
Nevada Medicaid and Nevada Check Up cover service for both
optometrists and ophthalmologists. An optometrist is trained to
examine eyes and prescribe eyeglasses. An ophthalmologist is a trained
medical doctor who specializes in eye diseases and can perform eye
surgery.
Your provider will show you a selection of frames that you may
choose from that Nevada Medicaid or Nevada Check Up pays in full.
You can choose more expensive eyeglasses; however, you must pay
the difference between what Nevada Medicaid and Nevada Check Up pay and
how much more the glasses cost. Make sure you sign an agreement if you
are going to pay for more expensive glasses.
Contact lenses are only covered if there is a medical reason for
them.
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Home Health Care
Home health care is for people who are homebound and for people
who cannot go to the doctor�s office for needed care but do not need to
be in a nursing home. Home health care requires prior approval from
Nevada Medicaid and Nevada Check Up.
Some benefits you might receive in your home are:
|
Physical Therapy |
|
Skilled Nursing Services |
|
Home Health Care Aides |
If you need home health care talk to your doctor. Your doctor must write an
order. Give the order to your home health agency. The home health agency
will ask Nevada Medicaid or Nevada Check Up for prior approval.
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Hospice Care
Hospice care is for terminally ill individuals. Hospice care
helps people to be comfortable when they are dying. Talk to your doctor
if you need these services.
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Hospital Care
Nevada Medicaid and Nevada Check Up cover both inpatient and
outpatient hospital care. Before you use hospital services get a
referral from your doctor.
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Lab and X-ray Services
Lab and X-ray services are covered by Nevada Medicaid and Nevada
Check Up. These services may be available in your doctor�s office or
your doctor may refer you to another clinics, lab, or hospital for the
service.
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Maternity Care
If you think you are pregnant, see a doctor as soon as possible.
Early maternity care helps you give birth to a healthy baby.
You may choose to see a specialist such as an
Obstetrical/Gynecological (ObGyn) or a Certified Nurse Midwife.
|
Nevada Medicaid Covers: |
|
Prenatal visits, lab work and tests you may need (such as an
ultrasound) |
|
Charges for labor and delivery |
|
Anesthesia (pain treatment) |
|
The hospital stay |
|
Your 6 week checkup after the baby is born |
You are allowed to stay in the hospital for 48 hours after a
normal birth and 96 hours after a C-section. You can choose to have a
shorter stay if you and your doctor agree.
Your baby can be covered by Nevada Medicaid for a year. Call your
Welfare Division case worker as soon as possible to report the birth of
your baby. Ask your Welfare Division case worker how to get the baby
covered for the year.
Nevada Check Up provides ongoing care for children for as long as
income levels are met and premium payments are current.
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Medical
Supplies/Equipment
Nevada Medicaid covers many medical supplies. For example, some
supplies you may need are:
|
A Wheelchair |
|
Prosthetic devices |
|
Wound care supplies |
|
Oxygen |
Talk to your doctor if you need medical supplies. Your doctor will write a prescription and give the order to a
medical supply company. The medical supplier must get prior approval
from Nevada Medicaid and Nevada Check Up for some items. Nevada Medicaid
and Nevada Check Up will reimburse the provider for the supplies and
equipment.
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Mental Health
Mental health services are those techniques, therapies, or
treatments provided to an individual who had acute, clinically
identifiable psychiatric disorders or chronic disorders. Some of the
services provided include:
|
Inpatient-Outpatient services |
|
Psychiatric Evaluations |
|
Medications Management |
|
Psychological Testing |
|
Case management |
|
Individual and Group Therapy |
|
Emergency care in the ER |
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Midwife Services
You may choose to see a midwife for your pregnancy. You must
choose a certified and licensed midwife who is a Nevada Medicaid or Nevada
Check Up Provider. Some certified midwives can deliver babies in the
hospital in case of an emergency during delivery.
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Nursing Facility
Nevada Medicaid and Nevada Check Up cover nursing home care. Long
term care is when a person stays in a nursing home more than 30 days.*
*Pre-authorization
is a requirement.
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Out-of-State Nursing Facility
Out-of-State nursing facility services are offered to Nevada
residents when:
|
An individual is unable to find placement in a Nevada nursing
Facility; |
|
An individual�s residence is located on or near a Nevada border
and the residents of the community customarily seek medical
service from out-of-state providers. |
|
Pre-authorization is a requirement. |
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Over-the-Counter Drug List
Listed are some common brand names to help you know what the
medications are. Your prescriptions will be filled with the generic
brand. This list does not include all medications covered by Nevada
Medicaid and Nevada Check Up.
|
Acetone tests |
Actifed |
|
Alcohol Swabs |
Antacid liquid and tablets (Tums) |
|
Aspirin |
Axid AR |
|
Benadryl |
Buffered Aspirin |
|
Calcium tablets (but not oyster shell) |
Chlor-trimeton |
|
Citrate of Magnesia |
Codimal DM |
|
Contraceptive creams, foams, sponges, tablets, condoms |
Dramamine
|
|
Drixoral
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DSS caps, liquids, syrup and concentrated drops 5% |
|
Dulcolax |
Ecotrin-enteric coated aspirin |
|
Glucose blood tests, Chemstrip BG, One-touch, Ultra etc.
|
Glucose urine tests, Clinitest, Clinistix, Diastix, etc.
|
|
Glutose |
Byne-Lotrimin |
|
Hydrocortisone cream, ointment or suppositories |
Imodium AD
|
|
Insulin
|
Insulin Syringe (with disposable needle) 100 max |
|
Iron Supplement |
Kaopectate |
|
Lancets |
Lotrimin, Lotrimin AF |
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Maalox suspension |
Mag-Carb |
|
Metamucil |
Milk of Magnesia |
|
Monistat 7 |
Motrin tablets or drops |
|
Mycelex OTC |
Miacin 250 mg, 500 mg |
|
Naldecon DX |
Neosporin ointment |
|
Nix |
Pedialyte |
|
Pepcid AC |
Pepto-Bismol |
|
Ploy Vi Sol (under age 5)
|
Prophylactics or condoms, male and female |
|
Rid |
Robitussin and Robitussin DM |
|
Sudafed |
Tagamet HB |
|
Tavist D |
Tavist 1 |
|
Tri Vi Sol (under age 5) |
Triaminic line |
|
Tylenol |
Zantac 75 |
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Personal Care Services
Personal care services such as bathing, feeding and dressing may
be covered by Nevada Medicaid and Nevada Check Up. The benefit is for
people who cannot perform these activities for themselves.
Personal care is provided by a Personal Care Aid (PCA). Talk to
the Medicaid District Office closest to you if you think you need the
services. The home health agency must get prior approval from Nevada
Medicaid and Nevada Check Up prior to providing services.
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Physical Therapy
Physical therapy may be covered for some serious problems. Physical therapy can
be ordered by your doctor if it will improve your medical condition. The
order is then submitted to a physical therapist who accepts Nevada
Medicaid and Nevada Check Up.
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Speech and Hearing
Services
If you have serious speech or hearing problems, see your doctor.
Your doctor can refer you to a speech therapist or an audiologist. Some
services covered by Nevada Medicaid and Nevada Check Up are:
|
Hearing Tests |
Hearing Aids |
|
Batteries for your hearing aid |
Speech therapy |
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Transportation Services
All Non-Emergency Transportation (NET) for Nevada Medicaid and
Nevada Check Up is coordinated through a transportation management
company, LogistiCare. For all NET services please contact:
|
Where�s My Ride?
888-737-0829 |
|
Reservation Line:
888-737-0833 |
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Waiver Programs
Individuals with special needs may qualify for Nevada Medicaid
and Nevada Check Up through special waiver programs. If you qualify, you
will also get enhanced benefits. Waivers let Nevada Medicaid and Nevada
Check Up pay for support and services to help people live safely in
their own homes or community. These services may include:
|
Emergency response service |
Homemaker service |
|
Group home |
Day treatment center |
|
A private nurse |
Family Support |
|
Respite care for family members who need a break from caring
for an individual |
Disabled or elderly family members |
|
Someone to help you work at a job
|
Transportation to places other than a doctor�s office or clinic |
These programs limit the number of people who may be served. For information
about how to apply for the waiver programs, call the Nevada Medicaid
District Office in your area or the Nevada Check Up toll free number
listed in the resource section of this guide.
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Privacy Information
Your health information is personal and private. The Division of Health Care
Financing and Policy (DHCFP) and the Bureau of Family Health Services
are required by law to protect the privacy
of the information we have about you. We receive this information when
we determine your eligibility for benefits. We also receive medical
information from your doctors (and other health care providers),
clinics, labs, and hospitals in order to approve care and pay for your
health services. Federal privacy laws require that we provide you Notice
of Privacy (NPP) that explains our legal duties and privacy practices
when dealing with your personal health information. We use health
information about you for treatment, to obtain payment for treatment,
for administrative purposes, and to evaluate the quality of care you
receive. Your health information is in a file that is the physical
property of the DHCFP. You may obtain a copy of our NNP form from our
offices and our web site at www.dhcfp.state.nv.us.
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Personal Representative
You may designate an individual of your choosing to represent you and your
interests with the Division of Health Care Financing and Policy (DHCFP).
This individual, known as your �Personal Representative,� has the same
rights to access, inspect, obtain a copy, request restrictions on
disclosures, request amendments or corrections, request an accounting of
disclosures, and request alternative means or location of communications
you have as the subject of the personal protected health information
held by DHCFP. You may obtain a form to designate someone as your
�Personal Representative� from your Nevada Medicaid District Office or
by calling the Nevada Check Up toll free number listed in the resource
section of this guide.
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Important Phone Numbers and
Locations You Should Know About
Nevada
Medicaid Central Office (NMO)
1100 East
William St STE 101
Carson City NV
89701
Telephone: (775) 684-3600
Las Vegas:
(702) 486-1550
Toll-free within Nevada: 1-800-992-0900
Electronic Verification Services (EVS) 1-800-942-6511
Nevada Check
Up Central Office
1100 East
William St STE 119
Carson City NV
89701
Toll-free number 1-800-360-6044
Nevada Medicaid District Offices
Carson City:
(775) 684-3651
Elko:
(775) 753-1191
Fallon:
(775) 423-6730
Henderson/ Las Vegas:
(702) 486-1550
Reno:
(775) 688-2811
Transportation:
1-800-737-0833
State Welfare District Offices
Carson City,
Eligibility
(775) 684-0800
Elko
(775) 753-1233
Ely
(775) 289-1650
Fallon
(775) 423-3161
Hawthorne
(775) 945-3602
Las Vegas-Belrose
(702) 486-1002
Las
Vegas-Cambridge Center
(702) 486-8770
Las Vegas- Cannon/DI Center
(702) 486-8504
Las Vegas-Charleston
(702) 486-4851
Las Vegas-Flamingo
(702) 486-9400
Las Vegas-Owens
(702) 486-1899
Pahrump
(775) 751-7400
Reno
(775) 448-5000
Tonopah (call Pahrump office)
(775) 486-6626
Winnemucca
(775) 623-6557
Yerington
(775) 463-3028
Nevada Check up
Toll-free within Nevada
1-800-360-6044
Carson City
(775) 684-3777
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