An Overview of Medicaid
Updated: Feb 18, 2019
Medicaid is a government program that pays necessary medical costs for needy persons, including the elderly, blind, and disabled. The provider sends the claim to Medicaid, and Medicaid pays directly to the provider, such as the doctor, hospital, nursing home, or pharmacist. Even though Medicaid does not always pay the provider’s usual fee, it is illegal for the provider to bill for amounts that Medicaid does not pay.
There are exceptions, however. In the following situations, the recipient may have to pay part or all of the bill: (1) if the service is not covered by Medicaid; and (2) if the provider does not participate in Medicaid. Both the federal and state government pay for Medicaid services and set rules for the program.
Medicaid coverage is broad. In Indiana, Medicaid will usually pay for the following medical services and for some services not listed. Some items require prior approval by the Division of Family Resources. The provider will take care of asking for the prior approval. Medical services include:
In-patient and outpatient hospital care
Laboratory and x-ray services
Intermediate care facilities for persons with mental retardation
Assisted living facilities, with a waiver
Home health services and other non-medical personal care
Medical supplies and equipment
Outpatient mental heatlh services
In-patient psychiatric care for persons under age 21 or over age 65
Dental services with a $600 limit per year on most services
Optometric services, including eyeglasses
Physical and occupational therapies
Speech pathology, audiology, and related supplies
Respirators, therapy, and related supplies
Private duty nursing
Transportation for Medicaid-covered services
Some of these services are optional services, meaning that the federal government does not require Indiana to provide the service. As a result, a service listed above may be “on the chopping block” as Indiana strives to contain Medicaid costs in the coming years.
You may choose the doctor, pharmacist, hospital, nursing home, or other provider who will care for you as long as that provider is certified by Medicaid. You do not have to go to the least expensive doctor. To make sure that the provider is certified by Medicaid, show your Medicaid card to the provider before you receive services. You can also ask Medicaid for a list of providers in your area who are certified. If you receive services from a provider who does not participate in Medicaid, you will have to pay the cost yourself.