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2025 Medicaid Managed Care Go-Live Investments

Geographic requirements: 

Applicants must operate and have headquarters or an office in rural Nevada, (not including) urban Clark county and urban Washoe county). Investments are only available to organizations located in, and serving, rural Nevada. (e.g.: Boulder City and Gerlach would be considered rural Clark and Washoe, respectively.)

Eligibility Requirements: 


Eligible applicants include Certified Community Behavioral Health Clinics (CCBHCs), primary care providers, specialty care providers, behavioral health providers, municipalities and community-based organizations actively serving Nevada Medicaid participants.

Candidates must legally operate a Nevada based 501(C)(3) organization, or be an educational institution, municipality, or a Nevada Medicaid provider.

  • Medical Service Providers MUST currently be contracted, or in the process of contracting, with SilverSummit Healthplan. 
  • For Community-Based Organizations, if delivering the new In Lieu of Services (ILOS) housing benefit, the organization MUST be contracted with SilverSummit.
  • For Community-Based Organizations not delivering the new ILOS benefit, organizations DO NOT currently have to be contracted with SilverSummit Healthplan.
  • Rural Health Clinics and Critical Access Hospitals ARE NOT eligible to apply due to other distinct funding opportunities. 

Note: These funds are not limited to use for SilverSummit Members and may support broader MMC preparedness.

SilverSummit Healthplan will not consider Investments for:

  • Individuals
  • Political action committees, candidates, causes or lobbying
  • Labor, alumni, or fraternal groups
  • Medicaid providers currently under investigation by the Special Investigations Unit (SIU)
  • Funding programs/services outside of Nevada
  • Medicaid-covered benefits and services

Eligible use of funds:

These funds are intended to strengthen infrastructure and expand service capacity by funding:

  • Hiring or onboarding staff to support MMC-related preparation or operations
  • Staff training on Medicaid billing processes, case management protocols, or service delivery under Medicaid & Managed Care
  • Technology investments, including hardware (laptops/tablets) or software upgrades (EMR systems, referral platforms)

Use Case Examples:

For Medical Providers (Primary Care, Specialty, Behavioral Health, CCBHCs):

Staffing:

  • Hire a Medicaid billing specialist to establish claim and coding protocols
  • Onboard a care coordinator to manage care transitions and track patient outcomes across systems of care

Training:

  • Provide training on billing workflows, prior authorization processes, or value-based care models that support Managed Care readiness
  • Facilitate workshops on prior authorization, referral workflows, and claims submission
  • Offer refresher courses for front office, billing, and clinical staff

Technology:

  • Upgrade EMR systems to meet MMC documentation and billing requirements
  • Software licenses for data tracking, care coordination, or referral management (e.g., Find Help, HMIS)
  • Purchase laptops or tablets for telehealth or mobile documentation

Communication:

  • Design community-friendly material on MMC changes, benefits, and health education topics aligned with state priorities 

For Community-Based Organizations (CBOs):

Staffing:

  • Hire a Community Health Worker or outreach specialist to help Medicaid members access services under MMC
  • Contract with a Medicaid billing consultant to support Managed Care readiness and claim submission preparedness

Training:

  • Train staff on Medicaid eligibility screening and proper documentation for reimbursement
  • Provide onboarding for referral platforms like Find Help or HMIS or EHR Systems

Technology:

  • Purchase computers or tablets for outreach teams to support mobile intake and screening
  • Invest in a HIPAA-compliant data system or CRM for case management and tracking

Ineligible use of funds: 

To ensure compliance and alignment with program goals, the following expenses are not allowed:

  • General administrative overhead or non-program-specific operating costs not related to MMC go-live
  • Any services that the benefit reimburses (Medicaid-covered benefits)
  • Funds can NOT be used for Housing Supports. 

To Submit Application: 2025 Medicaid Managed Care Go-Live Investments