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Fact Sheet
June 2003

Interstate Medicaid Billing Problems: Helping Medicaid Beneficiaries Who Get Care Out of State

Despite federal requirements that states pay for Medicaid services for beneficiaries who are absent from the state, Medicaid beneficiaries are frequently billed for such out-of-state care. Even when consumer health assistance programs intervene to advocate for patients, out-of-state providers often refuse to accept another state’s Medicaid payments and continue to bill patients. 

In May 2002, the Health Assistance Partnership asked CMS representatives about the processing of out-of-state Medicaid claims. In response, CMS representatives cited the relevant federal regulations and policy, which are discussed briefly.

This fact sheet examines several reported interstate billing problems. It also presents the results of a survey of states approaches to out-of-state billing. This lead to the development of a list of some practices for processing out-of-state Medicaid claims that, while not perfect, may provide more efficient alternatives. These practices are examined briefly. The piece finishes with recommendations to CMS.