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Medicaid covers health services for millions of America’s most vulnerable patient populations, including those who depend on physical therapy.

Medicaid is the nation's public health insurance program for eligible low-income people, families and children, pregnant women, the elderly, and people with disabilities.

While the federal government sets rules, regulations, and policies, each state administers its own program, establishing eligibility standards, setting payment rates, and determining the type, amount, duration, and scope of services. Some beneficiaries are enrolled in both Medicare and Medicaid and are referred to as "dually eligible."

Federal and state spending on Medicaid beneficiaries is often a target for legislators who are intent on controlling health care costs. As an optional benefit in states, physical therapist services are often in line to be cut or eliminated. In addition, Medicaid programs may contract with third-party administrators to perform utilization management and review of physical therapy services. While the intention of UM services is to improve cost effectiveness in health services, working with third-party administrators can be challenging.

APTA Members: Download the APTA State Medicaid Payment Rate Guide designed to provide you with information on the Medicaid fee-for-service payment rates for PT services provided by the various state Medicaid programs.

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