You are here: Home Government ... Medicaid 101 What Medicaid ... Other Requirements for ...
Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

What Medicaid Covers

Other Requirements for Medicaid Coverage

Next » « Previous


There is more to Medicaid coverage than the patient being covered under Medicaid and the service being a covered service. To be eligible for reimbursement by Medicaid each of the following must also occur:

In general, a doctor must prescribe the treatment.

For example, in the great majority of states Medicaid will pay for a prescription drug prescribed by a doctor, but will not cover the same or equivalent medication sold over-the-counter even though it would be cheaper. (Some states do cover over-the-counter drugs and first aid items whether or not prescribed by a doctor.)

Only services of a Medicaid-participating provider are covered.

All providers must be approved by Medicaid and must agree to accept the Medicaid payment as payment in full (except for small Medicaid-authorized co-payments).

Check with your state Medicaid agency, local disease specific nonprofit organization, or your medical network for names of doctors and other providers that accept Medicaid.

Treatment must be "medically necessary."

Medicaid plans rely heavily on the preauthorization process to assure coverage for procedures prior to delivery.

All hospital confinements, other high cost charges such as MRI exams, and treatment by ancillary providers such as home health agencies, chiropractors, or nurses, must be preauthorized before the service can be delivered. Usually this is handled between Medicaid and your doctor or hospital

No payment by you to providers.

Generally, Medicaid participating providers are prohibited from collecting any payment from you to supplement what the provider receives from Medicaid. For people who are Medically Needy, there may be a small co-pay for some services, a small monthly premium, and/or a small, one-time-only fee for enrollment into Medicaid.

Please share how this information is useful to you. 0 Comments


Post a Comment Have something to add to this topic? Contact Us.

Characters remaining:

  • Allowed markup: <a> <i> <b> <em> <u> <s> <strong> <code> <pre> <p>
    All other tags will be stripped.