One of the kinds of changes that is being proposed among legislators in Washington is an expansion of the Medicaid rolls. This means that more and more people will be added to the Medicaid program. Medicaid is a federally-funded medical insurance program that is administered directly by the states. This means that, among other things, Medicaid insurance can vary greatly from one state to the next. Medicaid is also very different from private medical insurance.

Acceptance

One of the things that makes Medicaid different is that it’s not necessarily as widely accepted as some insurance policies. In some areas, for example, the only general practitioner physician that will accept Medicaid is the local community health clinic, which is the same practice that offers services to those without insurance. The good news is that many specialists do accept Medicaid, as the number of specialist referrals is relatively low.

Part of the reason for this acceptance problem is the reimbursement rates. Many family doctors actually lose money any time a Medicaid patient walks through the door. Even though the Medicaid rates are supposed to be “reasonable and customary,” they are often too low for doctors to be able to accept.

Referrals and Primary Care

Another difference between Medicaid and some types of insurance is the referral process. While it can vary from one state to the next, most Medicaid programs operate like an HMO. They require you to chose a primary physician. That physician is responsible for your medical care.

That means you can’t go see a specialist without a referral from that primary care physician. If they don’t refer you to the specialist, you’ll be required to pay for the specialist visit out of your own pocket.

Reimbursement

Finally, Medicaid doesn’t reimburse an individual the way that some medical insurance plans might (although not all do this). For the most part, when you use Medicaid, you don’t pay up front. If you do, it’s usually a nominal co-pay. With some insurance companies, you pay the bill and are then reimbursed by the insurance company.

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