Since 1 January 2026, Nevada Medicaid managed care covers all 17 counties in the state through five managed care plans, with two plans serving rural counties and five serving urban Clark County. Every Nevada Medicaid member who is not in a specific excluded group now receives services through one of these plans instead of traditional fee for service.
Practices must know which plans serve each county to credential correctly and send claims to the right payer. This guide explains how to bill Nevada Medicaid under the 2026 managed care map.
The Three Nevada Medicaid Service Areas
Nevada Medicaid divides the state into three service areas: Urban Clark, Urban Washoe, and Rural. Urban Clark covers the urban portions of Clark County, Urban Washoe covers the urban portions of Washoe County, and the Rural service area covers all other counties plus the rural parts of Clark and Washoe. Each service area has a different set of managed care plans available to members, and practices must credential with every plan that serves their area.
The urban and rural split within Clark and Washoe counties is determined by zip code. Practices in these counties should verify which service area their office zip code falls into before deciding which plans to credential with, because the plan options differ between urban and rural designations within the same county.
Which Plans Serve Each Area
Urban Clark has five plans, Urban Washoe has four plans, and the Rural service area has two plans as of October 2026. The table below lists each managed care plan (MCO), its parent company, and the service areas it covers.
| Plan | Parent Company | Service Areas |
|---|---|---|
| Health Plan of Nevada | UnitedHealthcare | Urban Clark only |
| Anthem Blue Cross and Blue Shield Healthcare Solutions | Elevance Health | Urban Clark, Urban Washoe |
| Molina Healthcare of Nevada | Molina Healthcare | Urban Clark, Urban Washoe |
| SilverSummit Healthplan | Centene Corporation | Urban Clark, Urban Washoe, Rural |
| CareSource | CareSource (nonprofit) | Urban Clark, Urban Washoe, Rural |
Anthem Blue Cross and Blue Shield Healthcare Solutions is the trade name of Community Care Health Plan of Nevada, Inc., an Elevance Health company. CareSource is the only nonprofit managed care plan in Nevada Medicaid as of 2026.
Nevada Medicaid Plans by County
Every Nevada county is listed below with the managed care plans that serve it. Clark and Washoe counties are split into urban and rural service areas, with different plan options for each. All other counties fall entirely within the Rural service area.
| County | Main Cities/Towns | Service Area | Plans Available |
|---|---|---|---|
| Clark (urban) | Las Vegas, Henderson, North Las Vegas | Urban Clark | Health Plan of Nevada, Anthem, Molina, SilverSummit, CareSource |
| Clark (rural parts) | Rural Clark County | Rural | SilverSummit, CareSource |
| Washoe (urban) | Reno, Sparks | Urban Washoe | Anthem, Molina, SilverSummit, CareSource |
| Washoe (rural parts) | Rural Washoe County | Rural | SilverSummit, CareSource |
| Carson City | Carson City | Rural | SilverSummit, CareSource |
| Churchill | Fallon | Rural | SilverSummit, CareSource |
| Douglas | Minden, Gardnerville | Rural | SilverSummit, CareSource |
| Elko | Elko | Rural | SilverSummit, CareSource |
| Esmeralda | Goldfield | Rural | SilverSummit, CareSource |
| Eureka | Eureka | Rural | SilverSummit, CareSource |
| Humboldt | Winnemucca | Rural | SilverSummit, CareSource |
| Lander | Battle Mountain | Rural | SilverSummit, CareSource |
| Lincoln | Pioche, Caliente | Rural | SilverSummit, CareSource |
| Lyon | Yerington, Fernley | Rural | SilverSummit, CareSource |
| Mineral | Hawthorne | Rural | SilverSummit, CareSource |
| Nye | Pahrump, Tonopah | Rural | SilverSummit, CareSource |
| Pershing | Lovelock | Rural | SilverSummit, CareSource |
| Storey | Virginia City | Rural | SilverSummit, CareSource |
| White Pine | Ely | Rural | SilverSummit, CareSource |
Practices in Clark or Washoe counties must determine whether their office location falls in the urban or rural service area to know which plans to credential with. The zip code determines the service area designation within these counties.
What Changed on 1 January 2026
Rural Nevada members moved from fee for service into managed care for the first time on 1 January 2026, bringing managed care to all 17 counties. Members in rural counties were automatically assigned to either CareSource or SilverSummit Healthplan based on their zip code. The changes also affected plan service areas in Washoe County and rural Clark County.
- ✓Rural expansion: all rural counties moved from fee for service to managed care, with members assigned to SilverSummit or CareSource
- ✓Health Plan of Nevada limited its service area to urban Clark County only, exiting Urban Washoe and rural Clark
- ✓Members previously with Health Plan of Nevada in Washoe and rural Clark were moved to other plans
- ✓CareSource entered the Nevada Medicaid market as the only nonprofit managed care plan, serving all three service areas
Some members were exempted from automatic plan reassignment because of pregnancy, active treatment, or other specific conditions as of the transition date.
Who Stays in Nevada Medicaid Fee for Service
A portion of Nevada Medicaid members remain in fee for service and are not enrolled in managed care plans as of 2026. These excluded groups continue to receive services through traditional Nevada Medicaid fee for service billing.
- ✓Children in foster care and juvenile justice settings
- ✓People with disabilities enrolled in specific Medicaid waiver or exemption programs
- ✓Seniors age 65 and older who also have Medicare coverage
- ✓Members enrolled in home and community-based waiver programs
- ✓Children enrolled in the Katie Beckett program
Practices serving these populations bill Nevada Medicaid directly under fee for service rules, not through a managed care plan. The member's eligibility record will show fee for service status rather than a managed care plan name.
Choice Periods and Plan Changes
Rural members were automatically assigned to CareSource or SilverSummit Healthplan by zip code when managed care expanded on 1 January 2026. Members in Washoe County and rural Clark County who were moved from Health Plan of Nevada to a new plan could choose a different plan during a choice period that ran from 1 January 2026 through 31 March 2026.
After the initial choice period, Nevada Medicaid members can change plans during annual open enrollment periods or within 90 days of initial enrollment. Members may also request a plan change for cause at any time if they meet specific criteria set by the Nevada Health Authority.
What This Means for Your Practice's Billing
The managed care plan listed on the member's eligibility record determines where your practice sends the claim. A member's plan assignment can change during a choice period, annual open enrollment, or a for-cause request, so practices should verify plan information regularly to avoid claim denials.
- 1Check the plan assignment regularly: run eligibility and plan verification before each appointment, since a member's plan can change during open enrollment or a for-cause request.
- 2Credential with every plan in your service area: Urban Clark practices need all five plans, Urban Washoe needs four, and rural practices need SilverSummit and CareSource. Credentialing with each Medicaid plan takes 60 to 90 days, so start before you see members from a new plan.
- 3Send dental claims to LIBERTY Dental Plan: Nevada Medicaid managed care members receive dental benefits through LIBERTY Dental Plan, not through their medical managed care plan.
- 4Bill fee for service for excluded members: if the eligibility check shows fee for service rather than a managed care plan, send the claim directly to Nevada Medicaid using fee for service billing procedures.
Billing Nevada Medicaid Plans Without the Guesswork
Nevada Med Billing handles plan verification, credentialing, and claim routing for Nevada practices billing Medicaid managed care. We check which plan each member is enrolled in, send claims to the correct payer, and manage denials when plan assignments change mid-treatment. Contact us to learn how we keep your Nevada Medicaid claims moving to the right plan every time.
Sources
- Healthcare Dive — Nevada Medicaid managed care contract awards
- Fallon Post — CareSource explains Medicaid changes for rural Nevada
- Health Plan of Nevada provider notice
- Health Management Associates RFP summary
- Anthem Nevada Medicaid timely filing policy
- Nevada Medicaid billing manual
Last reviewed October 7, 2026.