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Families, advocates tell consortium providers are refusing care amid Medicaid MCO rollout
Summary
At the March 19 meeting, advocates reported that some providers are refusing to see families while they enroll in new Medicaid managed‑care organizations and that medications may not be covered; consortium members proposed inviting Nevada Medicaid’s managed‑care team to brief the group.
Advocates told the Washoe County Children’s Mental Health Consortium on March 19 that the Medicaid managed‑care rollout is disrupting access to services for some families, and consortium members discussed asking Nevada Medicaid to brief the group on enrollment and credentialing rules.
Carly Murray of Nevada PEP said her organization has heard from families who were told providers would not continue to see them while they enroll in a new managed‑care organization. "We've had a few families who are saying that their providers won't continue to see them because they can't get enrolled in the new MCO," Murray said.
Murray also said families reported medication changes after the MCO transition, a claim she described as inconsistent with how different Medicaid plans are supposed to work but that is nevertheless affecting families’ care. "…they've been told their child's medication has to change because the new MCO doesn't cover that medication," she said.
Consortium members discussed options to address the issues. Annie (the chair) asked whether it would be helpful to invite Medicaid staff; Sarah (an agency official) offered to connect the consortium with Nevada Medicaid’s managed‑care team and named Jamie Evans as the contact. Sarah suggested the team present an overview of what credentialing and enrollment requirements are supposed to look like across the MCOs so members can identify where breakdowns occur.
Why it matters: If providers or families face enrollment‑related interruptions, children may lose access to clinically necessary services during transitions between plans. Consortium members suggested agendizing a dedicated presentation from Nevada Medicaid to clarify rules and next steps.
Next steps: Members agreed staff should reach out to Nevada Medicaid’s managed‑care team to schedule a briefing and to follow up on specific family reports so the consortium can determine whether policy or operational changes are needed.
