Under 42 CFR 431.52, out-of-state coverage is required under a variety of circumstances. This citation says states must pay for services furnished in another state to the same extent it would pay for services furnished within its boundaries as long as the service is provided to an Alabama Medicaid recipient and any of four following conditions is met:
- Medical services are needed due to a medical emergency
- Medical services are needed and the recipient’s health would be endangered if he were required to travel to his state of residence
- The state determines, on the basis of medical advice, that the needed medical services, or necessary supplementary services, are more readily available in the other state
- It is general practice for recipients in a particular locality to use medical resources in another state
An out-of-state medical provider must agree to enroll as a provider with the Alabama Medicaid Agency. Some services must be approved before the service can be given by an out-of-state provider.