Frequently Asked Questions

Using Medicaid

Using your Medicaid benefits to stay healthy is important.
Below are some questions people often ask about using Medicaid benefits.  Click on the questions to see the answers:

Most Medicaid recipients are on Patient 1st. For those patients, a primary medical provider (doctor) has been assigned. To change PMPs, Medicaid has a list of providers on the website under "Managed Care." Foster children, people who have Medicare and Medicaid, and certain people already covered by a managed care program are not part of Patient 1st. These individuals may go to any Medicaid-enrolled provider who will accept their Medicaid coverage. Medicaid does not maintain a list of these providers since the decision whether or not to accept Medicaid is at the discretion of the provider.
If you are on the Patient 1st program, you will still need a referral from your Patient 1st doctor in order for Medicaid to pay for the visit. The doctor must also be enrolled with Medicaid and agree to file a claim to Medicaid. If you are not part of the Patient 1st program, you may see an any enrolled doctor who agrees to accept your Medicaid.
Doctors enrolled in Medicaid agree to accept Medicaid's payment, plus any co-payment as payment in full. The doctor or clinic may not charge or bill the recipient for cancelled or missed appointments.
A Medicaid dentist for a child may be found using the following link:
Medicaid does not cover orthodontics (braces) except under certain conditions. Services must be obtained through Children’s Rehabilitation Services (CRS) or another qualified clinic enrolled as a contract vendor with Medicaid. For more information, look at the fact sheet on Medicaid's website under Programs > Medical Services > Dental.
The recipient may be billed for services that are non-covered and for which Medicaid will not make any payment.Services that exceed the set limitation (for example, physician visits, hospital visits, or eyeglasses limit) are considered non-covered services. Medicaid does not reimburse providers for completing forms for school, family medical leave or other purposes not requested at the time of service. Providers may bill the recipient for this service under certain conditions. Providers are requested to confer with and inform recipients prior to the provision of services about their responsibilities for payment of services not covered by the Medicaid program.
Non-emergency outpatient hospital visits are not currently limited. However, most recipients will still need a Patient 1st referral. Examples of non-emergencies include upset stomach, sore throat, mild cough, rash and low-grade fever. Always call your regular doctor before going to the hospital for outpatient care.
As a Medicaid recipient, you may be asked to pay a small part of the cost of some medical services you receive. These payments range from 65 cents to $3.90 for most services, except for admission to a hospital which is $50 per admission. Medicaid will pay the rest Providers cannot charge any additional amount other than the copayment for Medicaid services. You do not have to pay a copayment if you are in a nursing home, under age 18, pregnant, receiving family planning services or are a Native American Indian with an active user letter from the Indian Health Services (IHS).
Medicaid pays for routine eye exams and eyeglasses once every year for children under age 21. Adults qualify to receive eye exams and eyeglasses once every two calendar years. Contact lenses may be provided only under certain conditions and when approved ahead of time.