Medicaid is a health insurance program designed to help people who do not have a lot of money pay for their medical bills. If you live in Nevada and your income is below a certain level, you may be able to get free or very low-cost health insurance.
Health insurance can be confusing. There are many strange words, long forms, and confusing rules. This article is a complete, plain-language guide to how Medicaid works in Nevada. We will explain exactly what this program is, who is allowed to use it, what kind of medical care it pays for, and how you can apply for it today.
By the end of this guide, you will understand how to check if your family qualifies and exactly what steps to take next.
To understand Medicaid, it helps to know how health insurance normally works. Usually, people get health insurance through their job, or they buy it themselves. When you have normal insurance, you have to pay a bill every single month just to keep the insurance active. This monthly bill is called a premium. When you go to the doctor, you often have to pay another fee out of your own pocket.
Medicaid is different. It is a public health insurance program. This means it is paid for by the government. Specifically, it is funded jointly by the federal government in Washington, D.C., and the state government of Nevada.
According to the official federal website, medicaid.gov, Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.
In Nevada, the program is run by the Nevada Department of Health and Human Services (DHHS). Because it is meant for people with limited income, Medicaid usually does not charge a monthly premium. If you are approved, you get a health insurance card that you can show to doctors, hospitals, and pharmacies. The state of Nevada pays them for your care.
Not everyone can get Medicaid. You have to meet specific rules. The most important rule is how much money you make. However, the rules are different depending on your age, whether you have children, and whether you have a disability.
Below, we break down the rules for the most common groups of people in Nevada.
For a long time, it was very hard for adults to get Medicaid unless they had children or were disabled. That changed when Nevada decided to “expand” Medicaid.
Today, most adults living in Nevada between the ages of 19 and 64 can get Medicaid based on their income alone. You do not need to have children to qualify.
To qualify, your household income must be at or below 138% of the Federal Poverty Level (FPL). The exact dollar amount for the Federal Poverty Level changes every single year because the cost of living goes up.
If you have children under age 19, the rules are much more generous for the kids. Nevada wants to make sure all children can go to the doctor and get medicine when they are sick.
Children can get standard Medicaid if the family income is at or below the standard limits. But what happens if you make too much money for standard Medicaid?
Nevada has a special program just for kids called Nevada Check Up. This is Nevada’s version of the Children’s Health Insurance Program (CHIP). Nevada Check Up covers children in families that make too much money for standard Medicaid but still cannot afford private health insurance.
Because of Nevada Check Up, many kids can get full health, dental, and vision coverage even if their parents do not qualify for anything. If your child is put on Nevada Check Up, your family might have to pay a very small premium (a small bill) every three months, but it is much cheaper than normal insurance.
If you are pregnant, getting medical care is incredibly important for you and your baby. Nevada Medicaid has special, higher income limits for pregnant women. This means a pregnant woman can make more money than a single adult and still get Medicaid.
If you qualify for Medicaid because you are pregnant, the coverage pays for your prenatal care (doctor visits before the baby is born), your labor and delivery at the hospital, and care after the baby is born.
In Nevada, Medicaid coverage for pregnant individuals lasts for the entire pregnancy and continues for 12 full months after the baby is born. This full year of postpartum coverage ensures that new mothers can get care for themselves while they recover. When the baby is born, the baby is automatically covered by Medicaid for their first year of life.
If you are age 65 or older, or if you are legally blind or have a recognized disability, you fall into a different category. The rules for this group are more strict.
For most adults and children, the state only looks at how much money you earn (your income). But for seniors and people with disabilities, the state also looks at your assets or resources.
Assets are things you own that can be turned into cash. This includes money in a savings account, stocks, bonds, or a second house. The state sets a strict limit on how much money you can have in the bank. (Usually, the home you live in and one car do not count against you). If you have too much money in savings, you will not qualify for Medicaid, even if your monthly income is very low.
Review these general rules to see if you might be eligible for Nevada Medicaid.
| Group | Income Rules (General Guide) |
|---|---|
| Adults (19-64) | Must be below 138% of the Federal Poverty Level. No asset limits. |
| Children (0-18) | Higher income limits allowed through Nevada Check Up. No asset limits. |
| Pregnant Women | Higher income limits allowed to ensure healthy births. No asset limits. |
| Seniors (65+) | Strict income limits AND strict limits on savings/assets. |
Many people get confused by the different types of government-supported health insurance. It is important to know exactly what Medicaid is compared to other options you might hear about.
| Program Name | Who is it for? | Est. Monthly Cost | Notes |
|---|---|---|---|
| Nevada Medicaid | Low-income individuals, families, children, and pregnant women. | $0 (Free) | Based mostly on your current income. Pays for nearly all medical costs. |
| ACA Marketplace | People who make slightly too much money for Medicaid. | Varies (often low) | You get tax credits to help pay the monthly premium. Based on yearly income. |
| Medicare | Seniors age 65 and older, and some people with long-term disabilities. | Varies (Set by feds) | Based on your age and work history, not your income. You can have this AND Medicaid. |
If you apply for Medicaid and the state tells you that you make too much money, you will not be left without options. Your application will automatically be sent to the Affordable Care Act (ACA) Marketplace.
On the Marketplace, you can buy private health insurance. Because your income is still modest, the federal government will give you a tax credit that pays for most of your monthly premium. This is called the Advance Premium Tax Credit (APTC). If you want to learn more about how taxes and health insurance work together, you can read our guide to Tax (APTC, Deductions) in Nevada in the related resources below.
If you get approved for Medicaid, what exactly does it pay for?
The federal government requires all states to cover certain basic medical needs. These are called mandatory benefits. Nevada also chooses to cover extra services, which are called optional benefits. Together, they form a very complete health insurance package.
Here is a plain-language list of what Nevada Medicaid covers:
Whenever you get sick, you can go to a primary care doctor. Medicaid pays for this. Medicaid also pays for routine physicals to make sure you are healthy. If your main doctor says you need to see a specialist—like a heart doctor or a skin doctor—Medicaid will pay for that specialist visit, too.
If you get badly hurt or suddenly very sick, Medicaid pays for the emergency room. If you have to stay overnight in the hospital for surgery or a serious illness, Medicaid pays for the hospital bed, the nurses, the operating room, and your food while you are there.
If your doctor writes you a prescription for medicine, Medicaid will pay for it at the pharmacy. You might have to pay a tiny copay (a few dollars), but often the medicine is completely free. The state has a list of preferred drugs. As long as your doctor picks a drug from that list, it is covered.
As mentioned earlier, all prenatal checkups, ultrasounds, hospital delivery costs, and postpartum care are covered.
Mental health is just as important as physical health. Nevada Medicaid covers visits to therapists, counselors, and psychiatrists. It also pays for programs to help people stop using drugs or alcohol safely.
Children get the best coverage of all. Under a federal rule known as EPSDT (Early and Periodic Screening, Diagnostic, and Treatment), children must receive all medically necessary care. This includes regular dental checkups, cavity fillings, eye exams, and eyeglasses.
If you do not have a car and cannot afford a bus, Nevada Medicaid provides a service called Non-Emergency Medical Transportation. You can schedule a free ride to your doctor’s appointments and back home.
Medicaid is meant for medical necessities. It will not pay for:
Once you are approved for Medicaid in Nevada, how you actually use your insurance depends on where you live. This is a very important rule to understand.
Nevada splits its Medicaid system into two different styles: Managed Care and Fee-For-Service.
If you live in a big city area—specifically in Washoe County (the Reno area) or Clark County (the Las Vegas/Henderson area)—you will usually be put into Managed Care.
A Managed Care Organization (MCO) is a private health insurance company that the state of Nevada hires to manage your medical care. The state pays the private company a set amount of money, and the company gives you a health insurance card with their logo on it.
You must choose an MCO when you get approved. If you do not choose one, the state will assign one to you. The private companies operating these Medicaid plans in Nevada often include major names like Molina Healthcare and Health Plan of Nevada.
When you are in an MCO, you must go to doctors and hospitals that are in that company’s specific network. If you go to a doctor who does not work with your specific MCO, the insurance might not pay the bill.
If you live in a rural area—meaning outside of Washoe and Clark counties—you will usually use traditional Fee-For-Service Medicaid.
In this system, there is no private middleman company. The state of Nevada pays your doctors directly. You get a regular Nevada Medicaid card. You can go to any doctor or hospital anywhere in the state, as long as that doctor accepts Nevada Medicaid.
Applying for Medicaid can seem scary, but the state has tried to make it as simple as possible. You do not apply through the federal marketplace (HealthCare.gov). Instead, you apply directly with the state of Nevada.
Here is exactly what you need to do.
Before you start the application, get your paperwork together. The state will ask for proof of who you are and how much money you make. You will need:
You have three ways to apply in Nevada.
Online (The Fastest Way): You can apply on the internet using a computer or a smartphone. The official website for Nevada residents to apply for state benefits is called Access Nevada. You can find links to it by visiting the official Nevada Department of Health and Human Services website. You will create a username and password, fill out the form online, and upload pictures of your documents.
By Mail: You can print a paper application from the Nevada Medicaid website. You fill it out with a pen, put copies of your documents in an envelope, and mail it to the local welfare office. Do not mail your original documents—only send copies.
In Person: If you need help, you can walk into a Division of Welfare and Supportive Services (DWSS) office. There are offices in Las Vegas, Reno, Henderson, and many other towns. You can sit down with a state worker who will help you fill out the application on a computer.
After you turn in your application, you have to wait. By law, the state has 45 days to process a standard Medicaid application. If your application is based on a disability, the process takes longer because they have to review medical records. For disability applications, the state has up to 90 days.
While you wait, the state might send you a letter asking for more information. For example, they might ask for a newer pay stub. Check your mail every day. If you do not reply to their letters, they will deny your application.
If you are approved, you will get a letter in the mail saying “Notice of Decision.” This letter is incredibly important. It will tell you the exact date your insurance starts. Shortly after, you will get your Medicaid ID card in the mail. If you live in an urban county, you will also get a packet asking you to choose your Managed Care Organization (like Molina Healthcare or Health Plan of Nevada).
What happens if you have medical bills from before you were approved? Nevada Medicaid has a rule called “Retroactive Coverage.” If you were eligible for Medicaid during the three months before you applied, Medicaid might pay those old doctor bills. You have to specifically ask for this help when you apply.
If the state says no, you will get a denial letter. The letter will explain exactly why you were denied. Usually, it is because they think you make too much money, or because you failed to send in a required document.
If you think the state made a mistake, you have the right to fight back. This is called an Appeal or a Fair Hearing.
The denial letter will have a form attached to it. You must fill out that form and send it back quickly (usually within 90 days). You will then get a chance to speak to a judge on the phone or in person. You can show the judge your pay stubs and explain why the state’s math was wrong.
Medicaid is not a lifelong guarantee. You only keep it as long as you qualify for it. Every year, the state of Nevada must check to see if you still meet the rules. This annual check is called Redetermination or Renewal.
Here is how the renewal process works:
Always Update Your Address: The most common reason people lose coverage is that they moved to a new apartment and forgot to tell the state. The state mails the renewal packet to the old address, the person never sees it, and their insurance is canceled. If you move, get a new phone number, or get a new job, you must report the change to Access Nevada right away.
Medicaid is not just for standard doctor visits. Nevada has several special programs designed for people with very specific needs.
Normally, if an elderly person or a person with a severe disability cannot safely live at home anymore, Medicaid pays for them to live in a nursing home. Nursing homes are very expensive.
Many people do not want to live in a nursing home; they want to stay in their own house. Nevada offers HCBS “Waivers.” A waiver is a special rule that allows the state to take the money it would have spent on a nursing home and use it to buy services in your own house instead.
If you get on a waiver, Medicaid might pay for a caregiver to come to your house every day to help you bathe, get dressed, and cook meals. They might pay for a wheelchair ramp to be built at your front door. The goal is to keep you safely at home for as long as possible.
We mentioned earlier that children usually qualify based on their parents’ income. But what if a family makes a good living, but they have a child with a severe disability? Private health insurance often will not pay for the massive amount of therapy and equipment a disabled child needs.
Nevada participates in the Katie Beckett program. This is a special rule for children under age 19 who have a severe disability that would normally require them to live in a hospital or nursing facility. Under this rule, the state completely ignores the parents’ income. They only look at the child’s income (which is usually zero). This allows middle-class and working-class families to get Medicaid coverage for their disabled child.
Navigating health insurance is a big task, but you now have a map. Nevada Medicaid is a powerful program that provides free or very low-cost medical care to people who need financial help.
If your income is below the limits we discussed, you should apply immediately. Go to the Nevada Department of Health and Human Services website, find the link for Access Nevada, gather your pay stubs and identification, and start your online application. Remember to read your mail carefully, answer any questions the state asks, and keep your address updated.
If you make too much money for Medicaid, do not panic. You can explore private plans on the ACA Marketplace and use tax credits to make them affordable.
By understanding the rules, knowing how Managed Care works in cities compared to Fee-For-Service in rural towns, and staying on top of your annual renewal paperwork, you can ensure that you and your family have the medical protection you need in Nevada.