Patients must use Medicaid doctors for medical services offered by the Medicaid program. The program will not pay for services by physicians who are not officially contracted with Medicaid.
As such, patients must find doctors who accept the insurance, or they could face out-of-pocket costs for each visit. Furthermore, Medicaid requires all program participants to select a primary care physician (PCP) to coordinate their care.
Individuals may find Medicaid providers through a variety of methods. They may contact their state’s Medicaid agency for a list of providers or they may ask their existing doctor a list of recommendations. Alternatively, they may contact the member services department for their managed care plan for a recommendation. In the sections below, beneficiaries can review the steps they may take to locate doctors that accept Medicaid.
Doctors that accept Medicaid have contracted with the program to provide services at a discounted rate. Therefore, a patient must choose a Medicaid doctor for all their care. The patient’s doctor is known as the patient’s primary care physician (PCP). The program requires patients to choose a PCP because it is the PCP who coordinates all the individual’s care. The PCP becomes familiar with the patient’s medical history and is the first point of contact for any medical issues. They are the one who provides services such as:
If a patient requires specialty care such as orthopedics or a heart specialist, the PCP refers the patient to the appropriate provider.
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Medicaid physicians are required to provide the equivalent level of care as any other doctor. Therefore, when a patient selects a Medicaid physician, they can be sure they are getting a doctor capable of providing them high-quality care.
Individuals may find doctors that accept Medicaid through a variety of methods. Through each method, individuals can search based on a variety of criteria that can help them narrow down the doctors on the Medicaid provider list. In each case, patients must still verify with the provider if they accept Medicaid, as a physician who was once a provider might no longer take the insurance. Below are several ways in which a patient may find a Medicaid provider:
Each state’s Medicaid program has a Medicaid provider list that patients may use to perform a Medicaid provider search. Individuals should visit the website for their state’s Medicaid program. The site will allow patients to search for a doctor based on a variety of criteria such as city, ZIP code, address or specialty. Individuals should look for a doctor within a convenient distance from their home. Selecting a physician nearby ensures that a patient seeks the care they rather than avoiding a visit just because the provider is too far away.
Individuals may use the Medicare website to use the Physician Compare tool to locate a provider who accepts Medicaid or Medicare. Individuals may search based location, specialty, body part or condition. Patients can also use this website to review additional resources like a glossary of definitions and frequently asked questions.
Many Medicaid programs offer care through what is known as a Medicaid Managed Care plan. With a managed care plan, patients receive an insurance card from a third-party insurance company. The card works as a regular insurance card that patients must submit when seeking care. The back of the card lists a phone number to the member services department. Patients may contact the member services department and request a Medicaid provider list. They can offer suggestions on Medicaid providers in their area or specialty providers that may accept the insurance.
If an individual is already receiving care from a PCP, they should ask if the PCP accepts Medicaid. If the provider does accept the insurance, the patient may continue care with the provider. However, if the PCP does not take Medicaid, the patient must locate a new provider if they wish to get care that is covered under the program. The provider may be able to refer the patient to another doctor who may accept Medicaid. Patients should ask the office if they could provide them with a list of Medicaid providers.
Medicaid contracts with not only standard physicians but Medicaid specialty doctors as well. As such, patients must still use Medicaid physicians even if they require the services of a specialist. Through the program, patients may only see a specialist with a referral from their PCP. When making the referral, the PCP will likely send the patient to a doctor who is on the Medicaid provider list. Before making the appointment, however, the patient must still verify if the doctor is still on the list.
There may be instances in which patients may not be able to locate a Medicaid physician. Beneficiaries may have trouble finding care in rural areas where access to Medicaid providers may be limited. However, individuals must use these specific physicians for the program to pay for the visits. As such, it is essential for patients to exhaust all measures to find someone who is on the provider list. One viable alternative is what is known as telemedicine. Through telemedicine, patients interact with their doctors in real-time using audio and video equipment. Using this approach, patients still get the care they need without a face-to-face visit. Patients may use any of the above means to locate a Medicaid doctor who may offer telemedicine.
There may be instances in which the doctor an individual wishes to see is not one of the approved Medicaid doctors. If the patient still wants to visit this specific the doctor, they will need to pay for the services out-of-pocket, as the program only pays for doctors that accept the insurance. Individuals may contact the doctor’s office to see if they can make a recommendation on a physician who may be on the Medicaid provider list. Alternatively, patients may use one of the above methods to locate a suitable provider.
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