medicaiad

Hello,    I just moved to Florida from Texas, my son is getting medicaid coverage threw ssi in texas till the end of the month will any Florida health care providers accept his medicaid ? also i have 2 other children who are on regular texas medicaid they are still coverd until the end of september and cant  reaply  in Florida untill October. will any florida health care providers accept there  texas medicaid if not what should i do ? I can not afford to pay outapocket for any visits they may need until october

[Amir Mostafaie]

Dear Tillery1Baby,

The Federal law pertaining to the creation of the Medicaid program, USC 42, recognizes that Medicaid beneficiaries sometimes receive healthcare services at facilities outside of their home states. This law, therefore, requires that Medicaid plan provide for the inclusion of out-of-state providers in their programs. The regulation states that Medicaid plans must provide a mechanism for paying out-of-state healthcare providers that treat the plan's beneficiaries.

The law says that a state must "pay for services furnished in another state to the same extent that it would pay for services furnished within its boundaries..." However, many providers that render service to Medicaid patients from other states often do not receive the reimbursement they are entitled to because they often do not carefully monitor this segment of their patients.

If you need to seek services in FL, I highly recommend the following;
a) Check with your case worker in TX to find out if your children’s coverage is impacted once you disclose that you have moved out of TX.

b) Accordingly disclose your type of coverage to your provider.

c) Be aware that special steps need to be taken to ensure your provider (doctor) receive payment for the services they provide to out-of-state Medicaid patients. These steps include billing for such services properly, investigating additional sources of reimbursement, appealing reimbursement decisions, and participating in bordering states' Medicaid programs as contract providers.

d) Be cautious of signing any documents that would hold you responsible for the reimbursement in case the provider is not able to get reimbursed.

Sincerely,

Amir Mostafaie