Receiving medical treatments in the US can be a very expensive procedure. Many people often worry about how they will be able to pay for their treatment.
Although national health insurance is available to those who are eligible, it is often a confusing process. It is not hard to become confused about what national health insurances cover.
Physical therapy is a treatment that can help people recover from many different issues. Whether they are recovering from injuries caused by a car accident or they have mobility issues as a result of a medical issue, physical therapy can help.
With so many people needing physical therapy it is no shock that many wonder if health assistance such as Medicaid will cover the expenses. In this article, we are going to look into whether Medicaid covers the cost of physical therapy.
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What Is Medicaid?
Medicaid is a program that helps to give health assistance to many Americans across the US. Medicaid has been able to help low-income adults that are eligible, pregnant women, children, people who are living with disabilities, and the elderly.
It’s funded by the federal government and individual states. The states are the ones that administer Medicaid, based on criteria from the federal government.
There are certain groups of people that are considered to be mandatory eligibility groups. For example, qualified pregnant women would be part of this group.
In terms of eligibility, it is a federal requirement that states cover certain groups of people. States also have the ability to add additional coverage for groups such as those receiving community-based services.
Eligibility for Medicaid is partly determined by financial status. Although, some groups are exempt from the way they determine eligibility, such as those with certain disabilities receiving Supplemental Security Income.
There are also some non-financial requirements that have to be met by the individuals, such as being a resident in the state that is providing the cover through Medicaid.
What Is The Difference Between Medicaid And Medicare?
Medicare and Medicaid are often confused with one another. Since the names of each program are similar it is no surprise that they are often mixed up. However, Medicaid and Medicare are two completely different types of programs.
Medicaid is a program that is for assistance, whereas Medicare is for insurance.
Medicaid is for low-income families and these people usually do not pay for any of the costs of the medical expenses that were covered. Whereas Medicare has different eligibility criteria, with it being aimed at those over 65.
Those who have coverage through Medicare usually pay part of the fee for medical treatments. For example, Medicare might cover 80% of the cost and the individual would pay the remaining 20% as well as the yearly deductible.
Medicare is a federal program, whereas Medicaid is a federal and state program. This means Medicaid varies from each state but Medicare does not.
Does Medicaid Cover Physical Therapy?
The question as to whether Medicaid covers the cost of physical therapy is one that is more difficult to answer.
As mentioned earlier, Medicaid is a health insurance program that is provided by both the state and federal governments. This means the cover can vary depending on what state you are in.
However, there is some data available about which states have previously granted Medicaid cover for physical therapy.
There is data from 2018 which identifies which states have who have covered physical therapy through Medicaid for those classed as categorically needy. This data does not tell us if the cover was provided for those classed as medically needy.
Here is a list of some of the states that gave cover for physical therapy from data taken in 2018:
- New Hampshire
- New Jersey
- New Mexico
- North Carolina
- North Dakota
These are not all of the states that have provided cover in the past for physical therapy. However, what this list does not tell you is that there might have been limitations to the cover, for example, some states might only provide cover for 15 physical therapy or rehabilitation sessions.
There is also data that has not been released from what was collected in 2018. This means some states not on this list or in the data may have provided cover.
When it comes to working out if Medicaid covers physical therapy, it is important to go through your state to find an answer relevant to your situation.
To simplify the answer to this question, Medicaid can provide cover for physical therapy sessions depending on the state you live in.
How Many Sessions Will Medicaid Cover?
Generalizing Medicaid coverage is extremely difficult since individual states administer it. Therefore, what one state might give coverage for, a different state’s coverage could be completely different.
For example, Kentucky had a limit of 20 sessions per year. Whereas, Nebraska provided cover for 60 sessions per fiscal year that included speech therapy, occupational therapy, and physical therapy.
In order for you to get a better understanding of the type of cover you might be able to receive if your state covers physical therapy, you should get in contact with your local Medicaid office.
At this office, you will be able to gain knowledge about how Medicaid cover works in your state.
Medicaid does cover the expenses of physical therapy treatments depending on the state you reside in. Since Medicaid is administered by each state, they are able to decide what they provide cover for.
So in order for individuals to get a clear understanding of whether Medicaid would cover physical therapy and how much cover they would get, they need to visit their local Medicaid office.
We hope this article has cleared up some of the misconceptions and any confusion about Medicaid coverage. Please share this article with others who might benefit from this information. Thank you for reading.
Frequently Asked Questions
Medicaid will pay for up to 20 physical therapy visits, 20 occupational therapy visits, and 20 speech therapy visits per enrollee in a twelve-month benefit year.
The cost of physical therapy without insurance or “out of pocket” will cost $75 – $150 per session. The price per visit will depend on your injury or particular condition. Your physical therapists near you will give you their estimate after thoroughly investigating your issues and developing a detailed treatment plan.
Chronic Services Chronic physical, occupational, and speech therapy services are benefits of Texas Medicaid for the medically necessary treatment of chronic medical conditions and developmental delay when a medical need is established for the developmental delay.