Does Medicaid Cover Chiropractic?

Does Medicaid Cover Chiropractic – Overview

The topic of Medicaid’s chiropractic care coverage extent is unnerving for patients in need of chiropractic services. After all, why wouldn’t Medicaid pay for chiropractic care if it would save the program money in the long run?

Medicaid coverage for chiropractic care depends on the state you reside in in the US. Your State will determine what will and will not be paid for chiropractic care. Each state has its list of eligibility requirements for chiropractic care.

This is because Medicaid is jointly funded and regulated by federal and state governments, though states can administer their programs within federal guidelines. However, more than ever, US States are starting to see the significance of paying for chiropractic care because spinal issues are rising.

Also, Medicaid saves money by paying for your chiropractic care when the spinal issue is relatively new and not as serious rather than waiting for when you require expensive pain medication or even an emergency room for treatment.

What is Chiropractic Care?

Chiropractic care is when a qualified physician or a chiropractor uses their hands or a small device to apply a controlled and swift force to a spinal joint. This procedure aims to enhance spinal movement and improve the body’s physical purpose.

The reasoning behind chiropractic care is that aligning the spine will let the body heal without needing drugs or surgery.

Manipulation is used to reinstate movement to joints limited by muscle damage caused by traumatic events such as sitting without proper back support.

Chiropractic care is mostly used as a pain reprieve alternative for bones, muscles, joints, and connective tissue such as tendons, ligaments, and cartilage. Chiropractic care is sometimes used on a patient alongside routine medical care.

Who Qualifies for Chiropractic Care Under Medicaid

As a Medicaid enrollee, you must present your Medicaid ID card before any services are rendered. The ID card is meant to verify your eligibility for a healthcare service covered by Medicaid. So, who qualifies for chiropractic care under Medicaid?

1. Chiropractic care is not deemed a mandatory Medicaid benefit under EPSDT; coverage for such services under EPSDT is determined by individual state Medicaid programs based on medical necessity.
2. Medicaid coverage for chiropractic care and any restrictions on the number of treatments per day are determined by individual state Medicaid programs and are not universally applied.

Which Chiropractic Care Services Are Covered by Medicaid?

Under Medicaid, Chiropractic care services are paid for when deemed medically necessary by a physician approved by Medicaid.

These include exams and diagnoses to influence the neurophysiological function of the spine region, including spinal X-ray procedures.

Some of the chiropractic treatments covered under Medicaid include:

Chronic Back Pain

Chiropractic care might be the best treatment option for you if you’re experiencing chronic back pain. Various chiropractic care cures can assist you in handling chronic pain in your back, such as a herniated disc.

Chiropractors are trained to examine and diagnose MSD (musculoskeletal disorder) conditions, and they will recommend a treatment plan or refer to another specialist such as a surgeon.

Some of the treatments Medicaid pays for chronic back pain include spinal mobilization and spinal manipulation.

Neck pain

Chiropractic neck adjustments, or cervical spine manipulation, are intended to loosen up the joints in the neck’s cervical vertebrae.

This can decrease the pain caused by muscle spasms, pinched nerves, strains, and other causative factors. Neck pain is usually caused by poor posture when sitting or sleeping and age-related wear and tear.

Spinal X-Rays

Medicaid covers spinal X-rays when the procedure is deemed medically necessary, among other requirements. The procedure is limited to one lateral and one anteroposterior view of the whole spine.

Medicaid coverage for spinal X-rays is based on medical necessity as determined by a qualified provider, but specific conditions that must be met for coverage can vary by state:

1. Current severe or intense trauma where there may be a question concerning fracture or avulsion of spinal subluxation.
2. Pre-existing or chronic illnesses that other qualified physicians have treated without long-term success.
3. When a malignancy or pathology is detected, precautionary spinal X-rays can be covered when medically necessary.
4. If there’s a symptom of a pre-existing malignancy in a patient’s diagnosis.
5. If a patient has been under long-term spinal treatment with no lessening symptoms.

Which Chiropractic Care Services Aren’t Covered by Medicaid?

Except for the abovementioned services, Medicaid will not pay for any other examination, diagnostic or treatment services provided by a chiropractor, whether approved or not.

Do You Need Prior Authorization for Medicaid to Cover Your Chiropractic Care?

The number of allowed visits to a chiropractor under Medicaid varies by state, and not all states impose a specific limit of 12 visits per calendar year.

Requirements for prior authorization for additional chiropractic visits under Medicaid depend on state-specific regulations.

If you don’t get prior authorization from your local office, Medicaid won’t pay for your chiropractic care services.

However, there are exceptions to this rule if you provide appropriate documentation, if the service provided is emergent or if you are retro-eligible for care services.

Retroactive eligibility is three months before the month in which a Medicaid application is filed, during which you can be eligible for Medicaid coverage as determined by your local Medicaid office.

Also, note that care services must be completed within the period stated by the prior authorization document; otherwise, Medicaid won’t pay for the services rendered.

Final Thought

If you visit a chiropractor for chronic back and neck pains, you can get treatments such as spinal manipulation, and Medicaid can pay for them depending on the state you reside in.

Chiropractic care is not universally a mandatory Medicaid benefit for pregnant women in their third trimester and children aged six or younger; coverage is state-dependent and based on medical necessity. To check if your plan can pay for chiropractic care, visit your local Medicaid office to learn more.

Medicaid Chiropractic Coverage FAQs

See Also

Does Medicaid Cover Braces?

Does Medicaid Cover Vision?

Does Medicare Cover Chiropractic?