The Medicaid program was created under the Social Security Act of 1965 just as Medicare was. Unlike Medicare, which is an entirely federal program, Medicaid is a joint federal-state program, with funding coming from both sources. Medicaid is an entitlement program that provides medical assistance to families and certain individuals with low incomes. Although the federal government sets broad guidelines for the Medicaid program, each state determines its own eligibility standards, scope of services, and payment rates.
Key Medicaid Information
- Because the program covers low-income individuals, Medicaid recipients typically have nominal, if any, copayments for services.
- Prescription drugs are not a required Medicaid benefit, but are covered under most programs. Medicaid beneficiaries who also have Medicare, dual eligibles, receive their drugs through Medicare Part D.
- For dual eligibles, Medicare is the primary insurer and should be billed first. Medicaid may or may not pay up to the beneficiary’s copay. This varies from state to state.
- Medicaid reimbursement rates are typically significantly lower than usual and customary fees, and are often lower than managed care and Medicare fees.
Note: Although the APA has been actively involved in advocating for full access to mental health treatment under Medicaid, due to the extreme variance inherent in the program structure, the APA cannot provide up-to-date information about an individual state's program services and fees. For information about an individual state’s Medicaid programs, contact the Medical Assistance office in your state.
Essential Health Benefits under the ACA
More online/print practice resources supported by OHSF:
Quick Practice Info Guides – Documents exploring common practice management issues encountered by psychiatrists.
Practice Management for Psychiatrists: The Basics [free online to Members. The e-book is posted both as a single document download and as a chapter-by-chapter download for ease of printing.
Information on Mental Health Parity can be found on the APA website www.psych.org under Managing A Practice or on the APA co-sponsored site www.parityispersonal.org.