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.
May 4, 2020 / Article
This resource summarizes the provisions under Cures as they relate to Medicaid enrollment requirements.
Jan 11, 2019 / Comment Letters
APTA comments to CMS on 2019 proposed changes to the Medicaid and CHIP Managed Care regulatory framework.
Feb 17, 2020 / Article
CMS also offers APMs focused on Medicaid beneficiaries. Here are the programs PTs need to know about.
Jan 1, 2020
Medicaid should put patients first.
Additional Medicaid Payment Content
Nov 30, 2022 / Members Only
Topics discussed: 2023 Medicare Fee Schedule, 2023 Home Health Rule, Commercial Payer Update.
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.
Aug 24, 2020 / Open Access
The proposed 9% cut: where it came from, what we’re doing, and the importance of your voice.
May 21, 2020 / Perspective
Due to COVID-19 millions of people have lost their jobs and consequently lost their health coverage. What happens then?
Dec 1, 2019 / Column
Use the information and resources here to get the details you need on regulatory compliance and related legal issues.
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.
Jun 18, 2019 / Article
There is no easy fix or silver bullet to the complex problem of student debt.
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.