While Medicaid has been used as a way to provide healthcare services to Americans for decades, individuals within the healthcare system, including pediatric providers, do not fully understand it. This makes it difficult to leverage the insurance effectively, which could put certain patients at risk.

To ensure success for every family in your practice, pediatric providers should always look for new opportunities to learn more about Medicaid. Dr. Suzanne Berman, Office Practicum’s Assistant Medical Director, recently joined our podcast to talk about this very important topic. She offers valuable insights to help pediatric providers develop a more thorough understanding of Medicaid and how it can benefit their patients and their practice.

What is Medicaid?

Medicaid was created in 1965 by the federal government. It was intended to provide lower-income adults, children, pregnant women, elderly adults, and people with disabilities medical assistance using federal and state tax dollars.

In 2010 the passing of the Affordable Care Act expanded Medicaid access, making it available to more individuals and roughly halving the number of Americans who were uninsured. Now, more than 88 million individuals are enrolled in Medicaid or the Children’s Healthcare Insurance Program (CHIP). 

How Medicaid Varies by State

While some funds for Medicaid do come from the federal government, the program itself is administered by individual states. This leads to noticeable differences in Medicaid policies, covered services, and reimbursements that vary by state. 

It’s crucial that pediatricians, practice managers, and billers understand how Medicaid works in their particular state rather than seeking out advice from providers or advocates working in other locations. The best advice will always come from your state’s Medicaid Agency. Don’t know how to get in touch with them? The American Academy of Pediatrics chapter in your state can usually point you in the right direction.

How Understanding Medicaid Can Help Your Patients

To help the patients in your practice grow into healthy adults, providers must ensure ongoing access to high-quality, affordable health care. For many families, this involves enrolling in and using Medicaid.

There are two common areas of Medicaid that can often be confusing for pediatric providers.

Billing. Practices that do not understand Medicaid billing may be at risk of not getting paid for the services they provide. Some practices actually find it easier to forego billing for Medicaid claims altogether, since it can be complex, and they get paid less per service than traditional insurance providers.

However, even though Medicaid offers roughly 70 cents on the dollar, it’s still preferable to receiving no money for their services, since clinics need to balance their budgets while providing quality care.

How Medicaid interacts with other coverage. Many families rely on Medicaid along with another form of primary insurance to ensure their medical needs are covered. Providers that don’t understand how to use Medicaid as a secondary insurance risk ordering medications, referrals, or procedures that will cost their patients heavily if they do not bill the right payer. 

Developing a better understanding of how Medicaid interacts with other forms of insurance carried by your patients can help ensure you never double or over-bill. 

When practices understand the nuances of the state Medicaid rules that are in place, they are better able to survive and thrive and help their patients do the same. Would you like to learn more about Medicaid and the best way to leverage it for pediatric success? Listen to the “Putting Medicaid Knowledge Into Practice” podcast now.