Rehab now more accessible to Nevada Medicaid recipients

Mary Hynes, Las Vegas Review-JournalLas Vegas Review-Journal

Residential treatment for addiction is expected to become more available to Nevada Medicaid beneficiaries this year, even as congressional Republicans consider cuts to the insurance program for low-income people.

In December 2022, the federal government gave approval for a requirement that managed-care organizations in Nevada cover residential treatment — live-in treatment at an addiction treatment facility — for up to 30 days, if “deemed medically necessary.”

But it took revisions to Medicaid’s complex rules on reimbursement before managed-care organizations broadly implemented the requirement, said Jeff Iverson, CEO of CrossRoads of Southern Nevada treatment center.

In October of last year, the federal Centers for Medicare & Medicaid Services gave approval for Nevada Medicaid to reimburse for residential treatment based on a bundled rate, allowing a higher reimbursement rate, according to Nevada Medicaid.

“Nevada Medicaid is expecting an uptick in the number of providers now that there is a more sustainable rate for this array of services,” the agency said.

Asked who’s to blame for the slow implementation, Iverson said, “There’s just a lot of finger-pointing. The MCOs blame the state.”

Nevada Medicaid said implementation required, in part, updating the software system to allow providers to bill for services. It also required coordination with another state health division providing grants to fund these services.

Meanwhile, managed-care organizations Anthem and Molina have been using a model of care that covered detox and outpatient treatment at CrossRoads coupled with off-campus housing and transportation to treatment, Iverson said.

Recently, all of the managed-care organizations, except for Health Plan of Nevada, have entered into contracts with CrossRoads to begin providing residential treatment, he said.

Health Plan of Nevada had a contract with CrossRoads in 2023 to provide services, including detox and residential treatment, but late that year began to deny treatment and refer its clients to outpatient clinics, Iverson said.

In a statement, Health Plan of Nevada said it provides access “to quality, evidence-based behavioral health care” for its members.

As of Jan. 1, a policy went into effect under which the managed-care organizations are beginning to cover residential treatment for Medicaid beneficiaries in the specialty courts of the Clark County court system, court spokesperson Mary Ann Price said.

One such court is adult drug court, a court-supervised, comprehensive inpatient and outpatient substance abuse treatment program for individuals dependent on alcohol or drugs. The aim is to address substance abuse issues to reduce recidivism.

Previously, the court obtained grants to cover treatment, said DeDe Parker, who a few months ago left her position as an administrator with the Clark County court system after eight years, including several as the administrator over specialty courts.

“The state wasn’t going to fund us because Medicaid was supposed to pick up funding residential treatment,” Parker said. “When I left, we were still trying to fight that.”

There was also an ongoing conversation, she said, about how individuals outside the court system could get treatment at all.

An average of 268 people over each of the past five years have received residential treatment funded through the court system, according to data from Price.

Contact Mary Hynes at [email protected] or at 702-383-0336. Follow @MaryHynes1 on X. Hynes is a member of the Review-Journal’s investigative team, focusing on reporting that holds leaders and agencies accountable and exposes wrongdoing.

Medicaid eligibility

In Nevada, households with annual incomes of up to 138 percent of the federal poverty level may qualify for Medicaid.

This is an income of about $20,800 a year for an individual and $43,000 for a family of four.

Also eligible are the following in households with somewhat higher income levels, depending on the group:

— Children.

— Pregnant women.

— Parents or caretakers.

— Supplemental Security Income recipients, including blind or disabled individuals.

— Certain Medicare beneficiaries.

Source: Nevada Medicaid

(null)