Frequently Asked Questions

Medicaid Benefits

Below are some questions people often ask about Medicaid benefits.  Click on the questions to see the answers:

Office visits are limited to 14 visits per calendar year. Recipients are encouraged to plan their visits carefully. The only exception would be an EPSDT-screened child under the age of 21 who qualifies for extra Medicaid benefits. If additional care is needed, federal health clinics (FQHCs) and other public clinics may be able to help.
Medicaid covers well-child checkups for children based on the schedule set up by the American Academy of Pediatrics. This is a complete exam to see if a child is growing as he or she should and checking for eye and ear problems, sugar diabetes, low blood or sickle cell disease, stomach problems, and to see if additional tests or shots are needed.
A copy of Medicaid's Covered Service Handbook and other handouts may be found on the Agency's website at this link:
No. In order for Medicaid to pay for your care, you must go through the maternity program for your county unless you live in one of these counties: Autauga, Bullock, Butler, Crenshaw, Elmore, Lowndes, Montgomery and Pike. If you live in one of those counties, you may go to any OB doctor who accepts your Medicaid. A list of providers may be found on the Agency's website at Managed Care > Maternity Care. Call as soon as possible to start your care.
Alabama Medicaid does not maintain a list of Medicaid providers who are not in the Patient 1st program. This is because doctors who have signed up with Alabama Medicaid decide when--and--if they will see a Medicaid patient on a case-by-case basis. In this case it is up to the patient to find out ahead of time if the doctor will accept their Medicaid coverage. The exception to this is the Patient 1st program. Anyone in this program has a “personal doctor” (primary medical provider) who has agreed to see them for all of their medical care, or to refer them to other doctors or clinics if care is needed that they cannot provide.
Chiropractors are covered only for certain Medicare patients (QMB) or children referred as a result of an EPSDT screening.
Alabama Medicaid covers this type of bariatric surgery for Medicaid-eligible recipients between 18 and 64 years of age who meet certain medical criteria. Also, there are very specific prior authorization requirements needed by Medicaid ahead of time. Surgery for recipients who are under 18 years old and who have one or more immediate life-threatening co-morbidities will be considered for authorization on a case-by-case basis. Please discuss the possibility of lap band surgery and the steps needed with your doctor. This type of surgery for cosmetic purposes only is not covered.
Medicaid does not pay for cosmetic surgery or procedures. Medicaid may provide coverage for eligible recipients if a procedure is found to be medically necessary. These cases would require approval ahead of time (prior authorization).
Medicaid pays for eye exams and eyeglasses once every three calendar years for adults (21 and older) and once every calendar year for children under age 21.
Yes. As long as the psychiatrist is a Medicaid provider, the visit will be covered. A primary medical provider referral is not necessary.
Alabama Medicaid does pay for Emergency Room visits when a person has a serious health problem that he or she reasonably believes could cause serious damage to their health or body if they do not get medical care right away. For ER visits that are not urgent, Medicaid pays for three non-emergency outpatient hospital visits per calendar year. Examples of non-emergencies include upset stomach, sore throat, mild cough, rash and low-grade fever. There are no limits on outpatient hospital visits for lab work or x-rays.
The Alabama Medicaid Agency does not pay for cosmetic surgery or procedures, dental services for adults, hearing services for adults, infertility services or treatment, hospital meal trays or cots for guests, TV rentals in hospital rooms, respiratory, speech and occupational therapy for adults, recreational therapy or experimental treatments, supplies, equipment or drugs, or sitter services. Services may only be covered for people who are eligible for Medicaid. Medicaid also does not cover services to people who are in jail or prison.
Medicaid recipients may be asked to pay a small part of the cost (co-payment) of some medical services they receive. Medicaid pays the rest. Providers cannot charge any additional amount other than the co-payment for Medicaid-covered services. Co-payments range from $1.30 to $3.90 for each visit, and between 65 cents and $3.90 for prescription drugs and medical supplies and appliances. When a Medicaid recipient is admitted to the hospital, the co-payment is $50. Some services do not require a co-payment, including birth control services, case management, chemotherapy, emergencies, home health care services, mental health and substance abuse treatment services, outpatient physical therapy, radiation treatment, and kidney dialysis, among others. Co-payments are not required if the recipient is in a nursing home, under age 18, pregnant or a Native American Indian with an active user letter from the Indian Health Services (IHS).
The Alabama Medicaid Agency covers medically necessary services for adults and children. In order for Medicaid to pay for your medical services, you must be covered at the time of the service, be getting a medical service that Medicaid pays for. Also, you must not have used up all of your available visits.
Services may be provided out-of-state in the case of an emergency and when it would be hazardous to have the patient travel back to Alabama for treatment. Any out-of-state provider must agree to enroll with Alabama Medicaid, accept Medicaid payment and agree to file a claim for services.
Medicaid pays for emergency and non-emergency outpatient hospital visits when medically necessary. There are no limits on outpatient hospital visits for lab work, x-ray services, radiation treatment, or chemotherapy. Medicaid also pays for three outpatient surgical procedures per calendar year if the surgeries are done in a place called an Ambulatory Surgical Center.