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Recently lost Medicaid in Nevada, now what?

You may qualify for a Special Enrollment Period to get enrolled in a Qualified Health Plan through Nevada Health Link!

What are your options if you lose Medicaid coverage?

If you had Medicaid coverage and lost it, or will lose it soon, you should contact Nevada Health Link or an Certified Enrollment Counselor or Broker/Agent in Nevada and see if you’re eligible to enroll in coverage through a special enrollment period.

If you know you will lose coverage, you can enroll in a qualified health plan up to 60 days prior to your loss of coverage, with a coverage start date based on your loss of coverage. This will allow you to avoid a gap in coverage dates.

Why were you denied Medicaid coverage or Minimum Essential Coverage (MEC)?

Medicaid eligibility depends on many various specifications. Below are some reason why you could be dropped from Medicaid coverage:

  • Your income changed and you now make too much to remain on Medicaid
  • You lost your minimum essential coverage (MEC)
  • You are not pregnant or no longer pregnant
  • You are not under a specific age – you aged out of Medicaid coverage
  • You acquire, win, or are given assets that modify your financial status
  • You fail to report a family change like getting married or adopting/having a child

What if you were denied Medicaid, but never had coverage?

If you were denied Medicaid/Nevada Check-Up outside of Open Enrollment after you applied during OEP, Nevada Health Link will permit a SEP due to Medicaid/NV Check-Up assessment application submitted during OEP and denial after OEP has ended. Consumers need to:

  • Pick a plan within 60 days of denial
  • Documents indicating the denial must be submitted within 30 days of choosing a plan
  • Coverage starts when your premium is paid the first day of month after you pick a plan
  • Need a different start date or need technical assistance? Contact us by calling 1-800-547-2927
  • Learn more about SEPs and how to submit documents and what are the correct documents to submit.

However…

A Medicaid denial alone, without a loss of coverage, does not generally allow for a Special Enrollment Period for mid-year enrollment.

What if you enroll in a Qualified Health Plan and then gain Medicaid eligibility after Open Enrollment?

Federal law will not allow anyone to receive tax credits and subsidies through the Exchange while they are eligible for Medicaid coverage that counts as Minimum Essential Coverage. As soon as you or anyone in your household gains coverage, they should dis-enroll from their Nevada Health Link plan if it is subsidized.

Important: If you are enrolled in coverage through Nevada Health Link, it’s important that you notify us as soon as you learn you are newly eligible for Medicaid. You may end up having to pay full price coverage while receiving Medicaid benefits. In addition, you may be required to pay back the subsidies you received while duly enrolled.

If your Medicaid program counts as minimum essential coverage: You are not eligible for a premium tax credit or other savings to enroll in a Nevada Health Link insurance plan. You should immediately end Nevada Health Link insurance for anyone in your household who is enrolled in these Medicaid programs and is also using premium tax credits with a Nevada Health Link plan.

If your Medicaid program DOESN’T count as minimum essential coverage: You are eligible for premium tax credits and other savings on a Nevada Health Link insurance plan, if you qualify based on your income and other criteria.

If you are eligible to enroll in coverage through Nevada Health Link and receive subsidies/tax credits, what are your NEXT STEPS in staying covered?

  1. Create account, Claim account, or Log in to your Nevada Health Link account at: https://enroll.nevadahealthlink.com
  2. Resume the application we received from DWSS, filling in any missing information and submit your eligibility application. You may be eligible for financial assistance including advanced premium tax credits (APTC) and/or cost sharing reductions (CSRs)
  3. Select your desired plan and get enrolled
  4. Make the first month’s premium payment to your insurance carrier

For FREE assistance with enrollment you can find a certified Broker or Navigator near you.

Questions?

Call us at 1-800-547-2927
Visit our FAQs on the platform
Send us an email at: CustomerServiceNVHL@exchange.nv.gov

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