What Is a Medicaid Physician?

A Medicaid physician is a doctor who accepts Medicaid as a form of health insurance. Medicaid is a program in the United States that pays for medical services for low-income people, people who have certain disabilities, and children. The name of the program sometimes differs among states. Not all doctors accept Medicaid, because it generally pays less than private insurance and takes longer to process payments. Sometimes Medicaid physicians take only new patients at certain times of the year.

Created in the 1960s, the Medicaid program is managed by the individual states of the U.S. It is funded by both state and federal governments. Eligibility differs among the states, but the program must be applied to and is geared toward people who have little income and assets. Likewise, a doctor who wishes to become a Medicaid physician must apply with the appropriate documents. A Medicaid physician who does not submit claims for reimbursements within two years is usually dropped from the program.

Medicaid is also known by the names Medi-Cal, Soonercare, and TennCare. The name differs among states, but a physician who accepts patients with these plans is still a Medicaid physician on paper. Even with the name change, many people still refer to Soonercare, MassHealth, and other state- and federal-funded health programs as Medicaid.

Some physicians cannot accept Medicaid because it pays significantly less than private insurance companies. In fact, sometimes a physician will accept Medicaid patients and give them care, but the physician loses money in the process. This is because the Medicaid program does not always offer enough money to cover the cost of a visit. A doctor’s visit costs much more than time, which is also valuable, but the cost of medical supplies like gowns and sanitary equipment adds up. In addition, Medicaid also tends to send payments out more slowly than private insurance companies, so the clinic does not receive the money to replace supplies until much later.

A common practice for clinics in the United States is to accept only a certain number of Medicaid patients. By doing this, the clinic’s budget is heavily supplemented with people who pay with private insurance or out of pocket. These amounts are usually significantly more than what Medicaid offers, so the clinic can easily afford to accept a certain percentage of Medicaid patients. Often the only way to find out if a clinic is open to more Medicaid patients is to call, because the receptionist will know whether to book a Medicaid appointment.