Copays are small amounts you may need to pay for a doctor visit, prescription, or medical service. If you’re on Medicaid, the only thing you should be paying for is small copays, usually between fifty cents and three dollars.

You can’t be denied medical care or services for not paying the copay. If you go to the pharmacy and can’t pay your copay, the pharmacy should still give you your medication. 

Always make sure your medical provider accepts your Medicaid plan before you get treatment. To find providers that accept your Medicaid plan, look at the website on your plan card. Once you find a provider, call them directly, since websites are often out of date.

When you go to your appointment, double-check at the front desk that your Medicaid plan is accepted.

Some treatments aren’t always covered under Medicaid. Before providing treatment, medical providers have to check with Medicaid to see if it will be covered — this is called prior authorization.

If your doctor isn’t sure if the treatment will be covered, they may suggest that you pay out of pocket and then ask Medicaid to reimburse you. Don’t pay for treatment out of pocket or sign a form saying that you will. It’s almost impossible to get reimbursed.

Sometimes, doctors say that Medicaid doesn’t cover something because it’s been denied in the past. Ask the doctor to put in the request anyway.

If Medicaid denies the request, you’ll receive a written denial, which will describe what services or situations are covered, and how to appeal.

If you need treatment right away, you can ask your doctor for expedited prior authorization. Medicaid will inform you about coverage within 72 hours. If it’s an emergency, you should go to the emergency room. Emergency room visits are almost always covered by Medicaid.

If you get a bill, it’s a sign there was a miscommunication somewhere along the way.

Step one is to read the bill. Don’t ignore it!

Step two is to call your medical provider and say: ‘I have Medicaid and shouldn’t have been billed.’

Step three depends on what the issue is:

• If the office doesn’t have your insurance info, provide your insurance details.
• If your Medicaid was closed or discontinued, call your insurance to find out what happened and how to reopen your plan. Remember to renew your Medicaid every year.
• If your provider said Medicaid would cover it but still sent you the bill, let them know this is illegal billing of a Medicaid consumer.
• If your provider doesn’t take your insurance, it’s harder to dispute the bill. That’s why it’s important to confirm coverage before treatment.

If you are having an issue with accessing Medicaid services or a billing issue, contact The Legal Aid Society for assistance. Call our Access to Benefits Helpline for support at 888-663-6880, Monday through Friday from 10:00 a.m. to 4:00 p.m.

The information in this document has been prepared by The Legal Aid Society for informational purposes only and is not legal advice. This information is not intended to create, and receipt of it does not constitute, an attorney-client relationship. You should not act upon any information without retaining professional legal counsel.