Medical Programs - General Information
What happens to you or a family member when you need medical attention? What do you do?
The Nevada Department of Health and Human Services offers medical assistance through a number of programs for individuals and families. Some of this coverage is free to you, and some requires a small fee. The services provided may include doctor visits, prescriptions, dental care, eye exams and glasses and therapies, to name a few.
The Medicaid Program is a state-administered, federal grant-in-aid program. Its purpose is to help meet the cost of medical services of those individuals receiving public assistance payments, and those individuals and families with low income. The program objective is to provide a broad range of medical and related services to assist individuals to attain or retain an optimal level of health care.
The Affordable Care Act (ACA) requires all individuals to maintain minimal essential health coverage beginning January 1, 2014. Individuals who do not maintain minimal essential health coverage may face tax penalties for noncompliance.
There are several Medicaid related programs for which DWSS determines eligibility. These programs include family medical groups, children's groups, specialized households, Nevada Check Up and Medical Assistance to Aged, Blind and Disabled (MAABD) groups.
Family Medical Coverage
- Medicaid coverage to low-income adults and children with income up to 138% of the Federal Poverty Level.
- Medical coverage (Nevada Check Up) to children, under the age of 19, with income up to 205% of the Federal Poverty Level.
medical assistance on a month-by-month basis for illegal non-citizens
or other non-citizens not covered in other eligible categories. These
applicants must meet all other eligibility requirements except for
- A pregnant woman eligible for Medicaid in any month of her pregnancy remains eligible for postpartum coverage.
children remain eligible for Medicaid for one year, if their mother was
eligible for Medicaid at the time of their birth. The newborn child
must continue to reside with the mother in Nevada.
- Medicaid coverage is available up to
three (3) months prior to the application month if an eligible household
member received medical services during this time. Eligibility is
determined on a month-by-month basis.
may continue for up to twelve months for parents or other caretaker
relatives who were eligible and enrolled in Family Medical Coverage in
at least 3 out of 6 months immediately preceding the month eligibility
is lost due to the increased income from employment.
- Medicaid coverage for individuals, under
age 26, who were in foster care in Nevada at the age of 18 and enrolled
in Medicaid while in foster care.
- Medical assistance to women who are under
age 65, are uninsured or underinsured, not eligible under any other
Medicaid eligibility group, have been screened for breast and cervical
cancer by the CDC, and are found to need treatment for either breast or
- Certain child welfare cases involving children for whom a public agency is assuming full or partial financial responsibility.
This program provides medical services and individuals may qualify by being eligible for a means-tested public assistance program (i.e., Supplemental Security Income [SSI]). Individuals may be eligible for medical coverage for up to three months of medical coverage prior to the month of application if they apply for or would be eligible in one of the listed categories.
The eligible categories for individuals include:
- Supplemental Security Income (SSI) recipients;
- Employed individuals, age 16 through 64 with disabilities with combined net earned and unearned income up to 250% of the federal poverty level (Health Insurance for Work Advancement);
- Nursing facility residents with gross monthly income up to 300% of the SSI payment level (State Institutional Cases);
- Certain individuals who have lost SSI eligibility, but would still be eligible if some of their income were disregarded (Public Law Cases);
- Disabled children who require medical facility care, but can appropriately be cared for at home;
- Aged or physically disabled individuals who require medical facility care, but can appropriately be cared for at home and aged individuals who have been residing in nursing facilities who can appropriately be cared for in adult group care facilities (Home and Community-Based Waivers); and
- Ineligible non-citizens who do not meet citizenship eligibility criteria and have emergency medical services may qualify for some limited Medicaid coverage.
Individuals eligible for Medicare may also qualify for benefits from the Medicare Beneficiaries program. Coverage provided by this program is different than other Medicaid groups as it does not provide the full scope of medical benefits. The categories described below may be eligible for Medicare Beneficiaries coverage:
- Qualified Medicare Beneficiaries (QMBs)
are Medicare recipients with income at or below 100% of the federal
poverty level. Medicaid pays for their Medicare premiums, co-insurance
and deductibles on Medicare covered services. Eligibility begins the
month following the month the decision is made.
- Special Low Income Medicare Beneficiaries (SLMBs)
are Medicare recipients with income between 100% - 120% of the federal
poverty level. Medicaid pays the Medicare Part B medical insurance
premium. Eligibility begins with the application month with three (3)
months of prior medical coverage available
- Qualifying Individuals 1 (QI-1s)
are Medicare recipients with income of at least 120%, but less than 135%
of the federal poverty level. Medicaid pays the Medicare Part B medical
insurance premium. Eligibility begins with the application month with
three (3) months of prior medical coverage available. However, this
program is 100% federally funded and ends if the state allocation is
- Qualified Disabled Working Individuals (QDWIs)
are Medicare recipients with income less than 200% of the federal
poverty level. Medicaid pays the Medicare Part A hospital premium, only.
Who should you call?
Contact your local Welfare Office or
Customer Service Voice Response Unit (VRU)
Toll Free (800) 992-0900
Northern Nevada (775) 684-7200
Southern Nevada (702) 486-1646