If you're enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), here are some things to know about coverage and care.
Using your coverage
For most questions, contact your state Medicaid or CHIP agency.
- If you’re enrolled in a health plan through Medicaid or CHIP, contact the member services phone number on your eligibility letter or the back of your enrollment card. This information should also be on the websites of your health plan or Medicaid or CHIP agency.
- Talk to your doctor or pharmacist. They may be able to answer questions about what services are covered.
Using emergency services: In an emergency, you should get care from the closest hospital that can help you. The law requires providers offering emergency services to examine you to determine if your medical condition is life threatening and provide medical care until your life is no longer in danger.
When to contact your state Medicaid or CHIP agency
Issues to take to your state Medicaid or CHIP agency include:
- You didn’t get an enrollment card and aren’t sure you’re covered
- You can’t find a doctor who accepts Medicaid or CHIP, or you can’t get an appointment
- You want to know if a service or product is covered
- You have a life change that may affect if you’re eligible for Medicaid or CHIP — like getting a job that increases your income, your dependent reaching an age where they no longer qualify, or getting married or divorced.
FILLING PRESCRIPTIONS IF YOU DON'T HAVE A CARD: If you need to fill a prescription and haven’t received your enrollment card yet, check if your pharmacy accepts Medicaid, CHIP, or your health plan. If they do, take your eligibility letter and prescription to the pharmacy. They’ll try to fill it using the information in the letter.
If they don’t have enough information, most pharmacies can give you enough medicine for 3 days. Call your Medicaid or CHIP agency or health plan for help getting the rest of your medicine.
If your pharmacy doesn’t accept Medicaid, CHIP, or your health plan, call the number in your eligibility letter to find a pharmacy you can use. You can usually find this information on the state Medicaid or CHIP agency website too.
- I haven’t received my enrollment card and I’m not sure I’m covered. What if I need care?
If you got a letter stating you’ve been enrolled in Medicaid or CHIP, you should still be able to get health care services. Show your provider a copy of your eligibility letter. Your provider can verify your enrollment.
- How do I find a doctor or pharmacist in my area that accepts Medicaid or CHIP?
- Ask your current doctor or pharmacist if they accept Medicaid, CHIP, or the health plan you selected. If you've been getting care from a provider who doesn’t accept Medicaid, CHIP, or any of its health plans, you may be able to keep seeing that provider for a short time until you can find another provider. But you need to ask your state’s Medicaid or CHIP program, or the health plan you selected.
- Most Medicaid and CHIP programs and health plans have websites that tell you what providers are available.
- Call your state Medicaid or CHIP agency or your health plan. The phone number should be on your eligibility letter, the back of your enrollment card, or your agency or health plan’s website.
When you make an appointment, be sure to tell your provider that you’re enrolled in Medicaid or CHIP, or give them the name of your health plan. If you’re having trouble getting an appointment, call your state Medicaid or CHIP agency or your health plan.
- What if I’m billed for a product or service that isn’t covered by Medicaid or CHIP?
You can ask your state’s Medicaid or CHIP program to review the provider’s bill. This is called an appeal.
- Your state Medicaid or CHIP agency’s website will have information on how to file an appeal. Or you can call your state agency or your health plan. They’ll help you with your appeal.