Medical Home

A Medical Home is the one place you and your child should go for all their health care needs:

• Checkups
• Sick visits
• Accidents
• Special health needs
• Immunizations (Shot)

A Medical Home is a doctor's office, community clinic, or a local health department. The staff there knows you, your child, and your health history.

Why do you and your child need a Medical Home?

You want to take your family to someone you know and trust. A Medical Home offers the very best care. Because the staff knows you and your child, they can:

• make sure you get the checkups, screenings, and shots you need to stay well
• work with you in planning your care
• tell you about community programs and resources that may be helpful
• help you locate the right specialists and equipment for you and your child

Then when you or your child is sick or hurt...

You have someone to call for help! The staff at the Medical Home can tell you if you should:

• treat your child or yourself at home. (they will tell you how)
• come to the doctor's office. (they will make an appointment for you)
• go to the emergency room. (the emergency room is for true emergencies - times when children may lose their life or risk their health without immediate treatment. it is rare when children need to be seen in the emergency room

22 Annual Medical Visits Covered by Medicaid

As of August 1, 2008, Medicaid has revised its policy on the number of visits recipients are allowed.  Medicaid now allows 22 visits to medical providers for those who are eligible.

Those not subject to the 22 visit limit include:

• Recipients under age 21.
• Recipients enrolled in a Community Alternatives Program (CAP).
• Pregnant recipients who are receiving prenatal and pregnancy-related services.
• Visits paid by Medicare that are also billed to Medicaid DO NOT count toward the 22 visits.

Allowed 8 Optional Visits

A total of eight (8) additional visits will be allowed for special medical visits that can be shared between Chiropractors, Optometrists, and Podiatrists.  These visits do not count against your 22 visits to regular medical providers.

What services count as a medical visit?

• Visits to your primary care doctor for primary medical care.
• Visits to a psychiatrist
• Some visits to a specialist when  referred by your primary care doctor
• Family planning visits (patients over 21 years of age)
• Some outpatient hospital services

Services that DO NOT Count Toward Your 22 Visit Limit:
The following services do not count as a visit toward your 22 visit limit:

• Physicals
• Physical therapy visits
• Mental Health facility visits
• Dental visits
• Visits to the Emergency Room
• Doctor visits to nursing home residents
• Home Health and Hospice visits
• Outpatient lab services or work done by an independent lab
• Pregnancy and prenatal visits

You need to be aware of the number of visits you make to your doctor.  If you exceed your 22 annual visits not including the 8 optional visits, your doctor’s office can bill you for any visit over the 22 visit limit.  Talk to your doctor or nurse care manager if you need more than the allowed visits.  They can help.