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 the services of a chiropractor. After all, why wouldn’t Medicaid pay for your chiropractic care if it would end up saving the program money in the long run?

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

This is because Medicaid is a state-by-state program, and thus its governed for the most part by state laws rather than federal laws.

However, today more than ever, US States are starting to see the significance of paying for chiropractic care because spinal issues are on the rise.

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

What Is Chiropractic Care?

Chiropractic care is a procedure in which a qualified physician or a chiropractor uses their hands or a small device to apply a controlled and swift force to a spinal joint. The objective of this procedure is 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 itself 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 at times 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 particular healthcare service covered by Medicaid. So who qualifies for chiropractic care under Medicaid?

  1. Chiropractic care is deemed a mandatory benefit under Medicaid for persons under EPSDT (Early Periodic Screening Diagnosis Treatment), typically pregnant women in their third trimester or children who are six years and older.
  2. Chiropractic care is only offered to a patient of 21 years and above if a qualified physician approved by Medicaid deems the treatment necessary. Medicaid won’t pay for more than one treatment per day per person.

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 under chronic back pain include spinal mobilization and spinal manipulation.

Neck pain

Chiropractic neck adjustments, also known as 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 aspects. Most of the time, neck pain is 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.

For Medicaid to pay for your spinal x-ray, at least one of the following conditions must be met:

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

Which Chiropractic Care Services Aren’t Covered by Medicaid?

Except for the services illustrated above, 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?

If you qualify for Medicaid coverage, you are allowed a maximum of 12 visits to a chiropractor in a calendar year.

Extra visits must be accompanied by a written prior authorization from the authorization unit in your local Medicaid office.

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

All in all, 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.

However, chiropractic care is considered a mandatory Medicaid benefit for pregnant women in their third trimester and kids aged six or lower. To check if your plan can pay for chiropractic care, you can visit your local Medicaid office to find out more.

See Also

Does Medicaid Cover Braces?

Does Medicaid Cover Vision?

Does Medicare Cover Chiropractic?


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