Medicaid Providers

When the federal government created Medicare to assist senior citizens and those with disabilities in finding affordable healthcare, they also created Medicaid. The Medicaid program was designed to fulfill a similar purpose by providing affordable health care access to those who could not otherwise find coverage. Medicaid on the other hand is a wider reaching program because it is available to individuals of any age who have low income and limited financial resources.

The Medicaid program is a joint effort between the states and the federal government. Funding for the program is generally approached on a 50/50 basis by the state and federal government, though this can vary in some states. States are responsible for administering the process on a day to day basis, while the Federal government is largely responsible for securing funding. Other federal responsibilities include:

  • Providing oversight on eligibility requirements
  • Ensuring states are providing quality care and reliable service

Because the states are responsible for administering the Medicaid program to citizens, the states provide oversight of Medicaid providers. Each state establishes their own set of eligibility guidelines and those providers willing to accept Medicaid payments for their services will take on Medicaid patients. Basic Medicaid eligibility guidelines include the following:

  • Low income
  • Lack of assets (including bank accounts, property, or other items) that could be sold for cash
  • Legal standing in the country: Only U.S. citizens and lawfully admitted immigrants may use Medicaid

In order to see a Medicaid provider, individuals must meet the above minimum requirements. There are other requirements that individuals must meet in order to use Medicaid’s services. Typically low income families with children, disabled children, pregnant women, and senior citizens in need of nursing home care. Eligibility requirements can vary from state and state, and even within certain eligible groups.

Medicaid works by sending money directly to Medicaid providers after they have treated a patient. Individuals searching for a Medicaid provider can often have a difficult time finding a provider because most providers only accept a certain number of Medicaid patients in a given time period. This can be attributed to the fact that Medicaid pays significantly less for services than private insurance companies tend to pay.

Just like other federal healthcare programs, such as Medicare, Medicaid providers can vary from state to state. Not every medical group that accepts Medicaid in one state will do so in other regions or states where they have offices. As mentioned above, it is often the pay level that deters Medicaid providers from enrolling in the program.

The best way for those in need of Medicaid’s assistance to find a provider is to go to the federal government’s website for Medicare and Medicaid. Here beneficiaries will be able to search a database of providers in their area who are willing to accept Medicaid payments. Individuals only need to have their home address and a few other details about themselves and/or their needs in order to get an accurate list of Medicaid providers near them.

In the event individuals cannot find Medicaid providers that work out for them, they can contact their state’s health department for assistance in finding a Medicaid provider. Working with state officials may be easier at times as the state government is in charge of directly administering Medicaid. It is important to remember at this point that patience can be valuable. Many providers, as mentioned, only accept so many Medicaid cases in a given period of time. Once they are willing to take on more Medicaid patients, these providers may be found on the list again.

Medicaid is a valuable tool designed to assist low income families, children, and senior citizens get access to good health care that they may not otherwise be able to afford. The Medicaid program could face huge uphill battles in the coming decade as the nation’s Baby Boomers near retirement and require ever more expensive healthcare and medical attention. As this happens, fewer and fewer Medicaid providers may exist as they battle for slimmer funds from the program for patient treatment.