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Fact Sheet
May 2002

Billing Disputes in Medicaid

How do states and health assistance programs handle billing disputes for Medicaid beneficiaries? 

Many Medicaid health assistance programs spend a great deal of time resolving health care billing disputes for beneficiaries. Medicaid is supposed to pay for their care, but beneficiaries often get billed. Sometimes, fixing these problems involves simply notifying a provider that a patient had Medicaid. Other times, disputes are more complicated - the provider is out of state or outside a Medicaid managed care plan, the bill has gone to an outside collection agency, or the beneficiary has signed a form accepting financial responsibility for a bill that should have been paid by Medicaid.

This fact sheet answers several questions about Medicaid billing, including:

  • What about out-of-state hospital or emergency room bills--can the provider bill the beneficiary?
  • Who can enforce the obligation of out-of-state providers?
  • How can health assistance programs help consumers through billing problems?  
  • What language have states put in managed care contracts or policy guidelines to protect consumers from wrongful billing by contracted providers? Has this language been effective
  • What systemic issues should be brought to the attention of national policymakers?