Medicaid health insurance is federally required to cover emergency room visits in all 50 states for “true emergencies”. “True emergency” status is based on symptoms, not final diagnosis, and if a reasonable person believes their symptoms constitute a medical emergency, Medicaid covers the visit. This is true of all Medicaid programs and health plans, including those for children, pregnant women, and people with disabilities. If a Medicaid recipient visits the emergency room and their visit is deemed a non-emergency, they may be required to pay a nominal co-pay, but otherwise, no deductibles or copays are required. Emergency room visits also do not require prior authorizations or referrals. Medicaid coverage for emergencies is comprehensive, often including services like x-rays, MRI scans, and prescription drugs. However, certain outpatient services are not covered, like family planning and primary care, preventative care.
Medicaid also covers mental health and behavioral health emergencies, just like it would cover medical conditions. Covered services include inpatient care, crisis intervention, and evaluations. Long-term care Medicaid also covers emergency room visits as part of Medicaid benefits. Medicaid covers room and board, and all other health care services, including transportation from the nursing facility to the hospital.
Medicaid beneficiaries may wonder whether their state’s Medicaid plan covers out-of-state emergencies. The answer is yes, emergency services for true emergencies are covered even in out-of-state facilities. However, non-emergency medical services like urgent care or regular doctor visits are not covered in out-of-state situations.
For more information regarding Medicaid coverage during emergencies, visit Medicaid.gov or your local Department of Health website.