Does Medicaid cover emergency room visits?
Yes, Medicaid is federally required to cover emergency room visits, no matter what state you live in.
However, the specifics of the coverage may vary depending on the circumstances of the treatment and the state you live in—so you may have to pay a small copay depending on your location.
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Emergency room Medicaid coverage by state#emergency-room-medicaid-coverage-by-state
Medicaid provides free or low-cost care, no matter which state you live in. Certain services, including some outpatient doctor visits, preventive care, and prenatal care, are free under Medicaid, as mandated by federal law.
However, federal law does not require Medicaid to cover the entire cost of an emergency room visit. That means the cost of an ER visit may vary by state. Sometimes, you may be required to pay a small copay when you go to the emergency room.
For example, under California’s Medi-Cal, emergency room care is fully covered. But, in Alabama, emergency room visits are only covered under Medicaid if it’s deemed an emergency.
And in Indiana, Medicaid recipients have to pay an $8 flat copay for emergency room visits for non-emergency care, but the copay is waived if the visit is declared an emergency.
The good news is that the cost of copays is capped under federal law. So even if your state doesn’t completely cover the cost of an emergency room visit, you’ll likely only pay a few dollars for the treatment.
Emergency room Medicaid coverage by circumstance#emergency-room-medicaid-coverage-by-circumstance
Coverage for an ER visit may also vary based on the circumstances of the trip.
If it’s a medical emergency and waiting for regular care could be dangerous, Medicaid is likely to cover the cost of the visit. It may be free or have a small copay. Some states have restrictions on coverage based on whether the visit is considered an emergency.
Non-emergency visits to the emergency room could result in a higher copay or require additional documentation for Medicaid coverage. In these instances, you’re encouraged to visit your primary care physician or an urgent care facility.
Other Medicaid coverage#other-medicaid-coverage
Depending on your state, you may have small copays for some other kinds of medical care, including:
- Prescription medications
- Inpatient stays
- Some dental care
Across all states, Medicaid is federally mandated to cover the cost of:
- Hospital stays
- Outpatient doctor visits
- Preventative care
- Prenatal care
- Nursing facility services
- Home health services
- CHIP (coverage for qualifying dependents and children)
