Will my NY medicaid work in LA, since expansion?

January 13, 2016 9:11 PM

I am going back to New Orleans for next month. Since medicaid was just expanded in Louisiana, in the event of a health emergency, will my NY state medicaid work down there?
posted by Kombucha3452 to Health & Fitness (4 answers total)

Medicaid should cover emergency treatment anywhere in the US; you should call the phone number on the back of your card to see what geographic restrictions are in place for urgent care and prescriptions.
posted by SMPA at 9:52 PM on January 13, 2016

Also: this is all based on the state you live in and their rules. Which state you're visiting is totally irrelevant as far as I know.
posted by SMPA at 9:54 PM on January 13, 2016

Medicaid participant enrollment and provider participation is managed at the state level in every state; Medicaid eligibility expansion in each state has nothing to do with your question. There's a few questions to consider in your situation. Could you be seen in the emergency room? Of course, an emergency room can't turn anybody away. Will NY Medicaid pay providers in LA for the services rendered? Maybe; often, providers need to do some sort of enrollment with the state before they can get paid, and it might not be worth the practice's time depending on how much money is at stake. Will the LA hospital/provider try to hold you responsible for any charges incurred if they can't get paid by NY Medicaid? Participating Medicaid providers are not allowed to balance bill Medicaid beneficiaries, but I'm unclear on whether balance billing is allowed if the provider participates in one state and the beneficiary is from another state they don't participate with. I will tell you that in practice, we never balance bill Medicaid beneficiaries from any state. We pursue enrollment when it makes sense to do so, and we write off the rest.
posted by ThePinkSuperhero at 5:37 AM on January 14, 2016 [2 favorites]

It depends. I've had (medical billing) experience with various state Medicaids being billed to another state for various procedures (inpatient/outpatient/ER) and some states are lenient with what they will cover and some are not. Some state medicaids will absolutely not cover any procedures that were performed out of state. Some will cover only ER visits that occured out of state. There may have even been times when a state medicaid covered non-ER visits out of state but none I recall specifically and is much less likely to be the case. I have no idea about your specific state but because there's no broad answer you should find out directly from your state medicaid yourself to be sure.

Also, in the off-chance there is an emergency visit, make sure you let the medical professionals know your insurance needs to be billed to your state medicaid. Believe it or not, even if they look at/get a copy of your insurance card and see that it's from another state, it's common that it gets billed simply to 'Medicaid' which will just be the Medicaid office for the state you're visiting. This can potentially save everyone time and dealing with denials and bills and making phone calls to rectify things ("you were supposed to bill it to New York Medicaid").
posted by atinna at 12:00 AM on January 15, 2016