Skip to main content

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.

Recommended Content

Medicaid Enrollment Requirements

May 4, 2020 / Article

Medicaid and Children's Health Insurance Plan Managed Care

Jan 11, 2019 / Comment Letters

Alternative Payment Models Under Medicaid

Feb 17, 2020 / Article

Medicaid Advocacy

Jan 1, 2020

Medicaid should put patients first.

Additional Medicaid Payment Content

Payment and Regulatory Update: Nov. 30, 2022

Nov 30, 2022 / Members Only

Topics discussed: 2023 Medicare Fee Schedule, 2023 Home Health Rule, Commercial Payer Update.

Advocating for Coverage: Template Letters

Jan 14, 2022 / Open Access

Access a variety of template letters you and your patients can use when your patient is denied coverage, the services approved are inadequate, or care is delayed, and a utilization management company is involved.

Proposed 9% cut: the history, what we're doing, and your role in the fight.

Aug 24, 2020 / Open Access

The proposed 9% cut: where it came from, what we’re doing, and the importance of your voice.

Navigating Health Coverage During a Pandemic: Three Options

May 21, 2020 / Perspective

Due to COVID-19 millions of people have lost their jobs and consequently lost their health coverage. What happens then?

Your Questions Answered

Dec 1, 2019 / Column

Use the information and resources here to get the details you need on regulatory compliance and related legal issues.

Getting a Handle on the Fee Schedule, Part 2: 4 Things to Know About the KX...

Nov 26, 2019 / News

Beyond the proposed payment cuts for 2021: four things that you should know about the 2020 physician fee schedule rule from CMS.

Student Loan Debt: APTA Member Sandra Norby Testifies Before House Committee

Jun 18, 2019 / Article

There is no easy fix or silver bullet to the complex problem of student debt.

Provider Enrollment, Chain and Ownership System

Jun 14, 2019 / Open Access

PECOS supports the Medicare Provider and Supplier enrollment process by allowing registered users to securely and electronically submit and manage Medicare enrollment information.