What actually changed in January 2026
On January 1, 2026, Nevada Medicaid moved to statewide managed care. Before the transition, managed care mainly covered urban Clark and Washoe counties while rural Nevada ran on traditional fee-for-service Medicaid. Now, Medicaid members across the state — including rural and frontier counties — receive services through a Managed Care Organization, or MCO: a health plan the state pays to administer Medicaid benefits.
As of the transition, Nevada Medicaid works with five MCOs: Health Plan of Nevada, Anthem, SilverSummit Healthplan, Molina Healthcare, and CareSource — the new entrant most families hadn't heard of before. As part of balancing enrollment across the five plans, the state redistributed some members automatically. That's the part that caught families off guard: some children were reassigned to a new plan — including CareSource — effective January 1, 2026, even if the family never requested a change.
The single most important thing to check this week
Find out which MCO your child is enrolled in right now. Don't assume it's the same plan as last year. Check the letter Nevada Medicaid mailed about the transition, log into your Access Nevada account, or call Nevada Medicaid member services. If your child was auto-reassigned and you'd prefer a different plan, Nevada allows plan changes: a 90-day window from your assignment date, plus the annual Open Enrollment period (October 1–31, effective the following January 1). Outside those windows, a "good cause" disenrollment request is still an option.
Does every MCO cover ABA?
Yes — ABA is a covered Nevada Medicaid benefit for eligible children with a qualifying diagnosis, and every MCO administers that same core benefit. The benefit follows your child; the plan just changes the phone number, the ID card, and — this is the part that matters — the provider network and the prior-authorization process.
What an MCO change means for your child's ABA services (the honest version)
- Network: your ABA provider must be in-network (contracted) with your child's MCO. If your child moved plans, confirm the provider is contracted with the new one. At Project MIND, we're in-network with Health Plan of Nevada and Anthem Medicaid. If your child was reassigned to SilverSummit, Molina, or CareSource and you want to keep or start services here, the 90-day plan-change window is your lever — and we'll walk you through the switch.
- Authorizations: ABA runs on prior authorizations. When a child changes MCOs, the existing authorization doesn't automatically transfer — the new plan issues its own. Continuity-of-care protections exist so services continue while that happens, but the paperwork has to actually get filed. A provider who bills Medicaid daily will drive this for you; ask yours directly: “Have you submitted to my child's new MCO?”
- The diagnosis requirement didn't change: Medicaid ABA coverage still requires a medical diagnosis from a physician or psychologist — a school evaluation alone doesn't unlock it. (We wrote a whole guide on that distinction.)
A checklist for parents (print this part)
- 1Confirm your child's current MCO (letter, Access Nevada, or member services).
- 2Call your ABA provider: “Are you in-network with [MCO]? Is a new authorization needed, and has it been submitted?”
- 3If you were auto-reassigned and want to switch plans, ask about the 90-day change window — don't just ride it out if your providers aren't in the new network.
- 4Keep every letter. Authorization numbers, member ID, effective dates — a folder (or a phone photo album) saves you a month of hold music later.
- 5If services were interrupted, say the words “continuity of care” to the MCO — it triggers a specific review process.
If you're just starting ABA under Medicaid
The path is the same as before the transition, with one extra check: medical diagnosis → choose a provider in your MCO's network → provider submits the authorization → services begin. If you're at step zero with only a school evaluation in hand, start with the diagnosis — and call us if you want help understanding the path. We walk families through it for free, whether or not they end up at Project MIND.