Module F: Medicaid Reimbursement

CE Credits: 1.75


Medicaid—the federal program that that serves many people with low incomes, special needs or disabilities—is one of the largest public programs in the U.S. This module begins by detailing which populations are eligible for Medicaid, and then explores how different factors (such as state regulations and the Affordable Care Act) have affected Medicaid. Last, it looks at two main challenges that can involve Medicaid: coordinating care when many providers do not accept Medicaid, and coordinating temporary Medicaid for patients who have fallen through the “safety net” of both Medicare and Medicaid.

Learning objectives: After completing this module case managers will be able to:
» Describe the Medicaid program
» Discuss Medicaid growth and spending
» Review state variations in Medicaid eligibility
» Discuss provider’s right to refuse Medicaid patients
» Identify alternatives when the Medicaid safety net fails


Advance your professional practice: It is critical that we, as case managers, understand how Medicaid affects the delivery of patient care and the revenue cycle of our organizations. When we know how to navigate the Medicaid system well, we can help our patients and maximize value for our organization.

Improve organizational performance: Medicaid assists patients who need the most help: the poor and the disabled, who often suffer from chronic illnesses and may make repeated ER visits for care. When we understand the regulations and best practices for Medicaid, we can help coordinate care for those who need it most, while still getting reimbursement for our organization.