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2.01.2026

Nevada Medicaid Managed Care Plans - Your Questions Answered

Adult female holding baby in the air, both looking at each other smiling. In a comfy home setting.

In 2025, the Nevada Health Authority announced changes to Nevada Medicaid including new Managed Care plans available statewide. The information below provides some common questions and answers from Nevada Health Authority about the Managed Care plans for Medicaid.

All members have 90 days from initial enrollment date to switch plans. Now is the time to review your plan to make sure you have selected the Managed Care plan that works best for you and your family!

  1. What is changing in 2025-2026?

Managed Care health plans will now be statewide.

Rural Nevadans: In October 2025, you should have received a letter that Managed Care health plans - CareSource and SilverSummit - will be available in your area. In December, you should have received a letter informing you which plan you were assigned. The plan assignments took effect on January 1, 2026.

Urban Nevadans: You have new health plan options. For this reason, Open Enrollment ran from October 1 to December 26th. Ask your doctors, providers, and pharmacies which plan(s) they are with and review the free extra benefits from each plan to help you pick.

ALL members have 90 days to switch to a different plan. Ask your doctors, providers, and pharmacies which plan(s) they are with and review the free extra benefits from each plan to help you pick. You can continue to use the same providers for up to 6 months, regardless of which plan you are with.

  1. What plans are available where I live?

Everywhere in Nevada:

In urban Clark County only: 

In urban Washoe County only:

  1. What is changing in rural Nevada?

Rural Nevadans can pick from two managed care health plans starting January 1, 2026: CareSource and SilverSummit. These plans will provide all the Medicaid benefits you’re accustomed to, and they will also offer new services.

  1. What is a Medicaid managed care health plan?

A Medicaid managed care health plan is health insurance offered by a state-licensed health carrier. The health plans connect Medicaid members to services through a network of doctors and providers. If you are a Nevada Medicaid or Nevada Check Up member, you should receive all of your covered services through the plan you pick, including physical and behavioral health services and prescriptions. Medicaid managed care health plans also provide care coordination and care management services to ensure you get reliable access to the health care services you need.

  1. When is Open Enrollment, and how do I change plans?

Open enrollment for urban members was from October 1st through December 26th, 2025.. Rural members were assigned a plan that was effective January 1, 2026. All members have 90 days to switch again. After that, they must wait until the next Open Enrollment period.  During the 90 day switch period, use the 90 Day Health Plan Change Form to make changes. After the 90 day window, you may only change plans if you have a good cause (see below) or when the next Open Enrollment period begins. 

  1. Can I change health plans outside Open Enrollment?

You can ask to change your health plan at any time if you have “good cause”. This is called “Disenrollment for Cause.” It’s for people who want to change plans when it's not Open Enrollment and who are not in the 90-day window.

To ask for a change, you must call or write to Nevada Medicaid or your current health plan. “Good Cause” reasons include:

  1. You moved to a new area that is not covered by your plan.
  2. Your plan does not cover services you need because of its moral or religious objections.
  3. You need medical services related to (for example, a cesarean section and tubal ligation) to be performed at the same time; not all related services are available within the network; and the recipient's primary care provider or another provider determines that receiving the services separately would subject the recipient to unnecessary risk.
  4. You use long-term services and support, and your care provider is no longer part of the plan’s network. If switching providers has disrupted your living or work situation, you may need to switch plans.
  5. Other reasons include poor quality of care, lack of access to services covered under the contract, or lack of access to providers who are experienced in dealing with the recipients’ care needs.

 

  1. What if I lose Medicaid and then get Medicaid back again?

If you lost Medicaid for 2 months or less, you’ll return to the same health plan you had before. If you were without Medicaid for more than 2 months, you can choose a new health plan, or Medicaid will pick one for you.

  1. What benefits do Medicaid health plans offer?

All health plans offer the same basic covered benefits, including physical and behavioral health services, transportation, and prescription medications. They also have different free extra benefits not typically covered by Medicaid.

Source: This article was adapted from the Nevada Health Authority document “Managed Care Health Plans: Questions & Answers” last updated on October 7, 2025. Click the link to see the full list of questions and answers from Nevada Health Authority.

Resources:

Nevada Health Authority – Health Plans Information

Nevada Medicaid & Nevada Check Up 90 Day Health Plan Change Form

Nevada Medicaid Managed Care Provider Overview and Free Extra Benefits Flyer

Nevada Good Cause Disenrollment Form – English

Nevada Good Cause Disenrollment From - Spanish

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First 5 Nevada, a program of The Children's Cabinet, is supported by the Preschool Development Grant Birth through Five Initiative (PDG B-5), Grant Number 90TP0099, awarded to the Nevada Department of Education, from the Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Nevada Department of Education, the Office of Child Care, the Administration for Children and Families, or the U.S. Department of Health and Human Services.

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