The Nevada State Legislature created the Division of Health Care Financing and Policy (DHCFP) within the Department of Human Resources in 1997.  DHCFP is responsible for the administration of the Medicaid and S-CHIP programs.

Eligibility is determined by the Welfare Division of DHR through local and district offices.

MEDICAID

Adults

Child Health Assurance Program (CHAP) for Pregnant Women

Income cannot exceed 133% of FPL.

Resources cannot exceed $2,000.

Eligibility continues for two months following the birth month.

Pregnant women are not considered presumptively eligible.

Breast and Cervical Cancer Treatment Program

Must meet citizenship or eligible non-citizen requirements.

Must be under age 65.

Must be uninsured or underinsured.

Not eligible under any other Medicaid eligibility group.

Must have been screened for breast or cervical cancer under the Women’s Health Connection.

Must need further diagnosis or treatment for either breast or cervical cancer.

Nevada Health Division case managers identify and refer uninsured women under age 65 who have been screened through the Women’s Health Connection.  A referral form and an application for assistance is submitted to the TANF Program Specialist in the Eligibility and Payments Unit of Central Office.

The Women’s Health Connection under the Health Division is Nevada’s Breast and Cervical Cancer Early Detection Program.

A woman’s eligibility ends when her course of treatment is completed, or she no longer meets the eligibility criteria for this category. 

A woman eligible under this category is eligible for all other Medicaid services.

Families/Children

Child Health Assurance Program (CHAP)

·         Newborn babies

·         Children age 1 through 5

·         Children age 6 through age 18

Born to Medicaid-eligible mother.

Income cannot exceed 133% of FPL

Income cannot exceed 100% of FPL

Resource limits: $2,000 for the first person, $3,000 for the second person and $150 for each additional person up to $4,200.

Newborns remain eligible for one year following birth, provided the child lives in the same household as the mother and the mother would be eligible for Medicaid if she were still pregnant.

Foster Children

Medicaid is available for some children for whom financial responsibility is assume in whole or part by a public agency.

Public agencies include county, state and Native American social service agencies.

Documented and undocumented aliens

Must meet eligibility requirements of any category.

May qualify for some, but not all, Medicaid services.

Undocumented aliens are entitled to emergency services only.

TANF

Temporary Assistance for Needy Families

·         Cash Assistance Program

·         TANF-Related Medical Only

One or both natural/adoptive parents must be deceased, absent, incapacitated or the total earned income of both parents must fall within TANF income limitations.

Children must be under age 18 OR be age 18 and attending school full time and expecting to graduate before age 19.

Countable resources cannot exceed $2,000 per case.

Child must be living with the individual applying for assistance on their behalf who provides care and supervision.

Home, one car, personal items/household goods, burial plot and burial funds are not included in countable resources.

There are several TANF-related medical groups, including (but not limited to) individuals who choose to receive medical benefits only, or who are ineligible to receive cash assistance due to TANF time limits, pregnant women and newborns.

Medicaid continues for up to 12 months for households that become ineligible for TANF due to increased earned income of the caretaker OR a loss of a disregard (exclusion) in the budgeting process.  Medicaid continues up to 4 months for households that become ineligible for TANF assistance due to child support collected through the agency.

Medically Needy (Spend Down)

There is no medically needy category in Nevada.

Elderly/Disabled

Medical Assistance for Aged, Blind and Disabled (MAABD)

·         Supplemental Security Income (SSI) recipients

·         Nursing facility residents

·         Disabled children who require medical facility care but can be appropriately 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 be appropriately cared for in adult group care facilities (Home and Community-Based Waivers)

Eligible for Medicaid based on eligibility for SSI.

Income cannot exceed 300% of the SSI payment level.

Income cannot exceed 300% of the SSI payment level.

Need not be eligible for SSI.

Income cannot exceed 300% of the SSI payment level.

Must apply with the Welfare Division for Medicaid eligibility – person is not automatically enrolled.

Medicare Beneficiaries Program

·         Qualified Medicare Beneficiaries (QMB)

·         Specified Low-income Medicare Beneficiaries (SLMB)

·         Qualified Individuals (QI-1)

·         Qualified Disabled Working Individuals (QDWI)

Income cannot exceed 100% of FPL.

Income must be between 100% and 120% of FPL.

Income must be at least 120% of FPL but less than 135% of FPL.

Income cannot exceed 200% of FPL.

The asset limit for the Medicare Beneficiaries Program is twice the SSI limit ($4,000 for one person and $6,000 for couples).

For QMBs, Medicaid pays Medicare premiums, coinsurance and deductibles on Medicare covered services.

For SLMBs, Medicaid pays Medicare Part B premiums.

For QI-1s, Medicaid reimburses recipients for Medicare Part B premiums. QI-2 no longer exists

For QDWIs, Medicaid pays Medicare Part A premiums.

S-CHIP

Nevada Check Up

Children from birth through age 18

Income cannot exceed 200% of FPL.

Quarterly premiums are charged according to income and family size.  Premiums range from $10/quarter to $50/quarter.

The following criteria must also be met:

·         Child is not eligible for Medicaid;

·         Child is a U.S. citizen or legal resident; and

·         Child has been uninsured for the last six months.(other than Medicaid).