Although some waiver programs cover music therapy services, core Medicaid does not. So you may be asking yourself why a music therapy practice is posting a blog about Medicaid changes as related to the Affordable Care Act. Well, let me explain…
As a therapist I make it a point to be involved in the overall care of my patients and their families. In addition, I see the struggles that many our families deal with on a daily basis just trying to get basic medical care for their loved ones, not to mention the additional cost related to therapy and prescription coverage. Many of our patients and their families are dependent upon Medicaid funding as primary and/or secondary insurance to cover required medical treatments and tests.
Therefore, if our families are affected, we as a community are affected.
There are new Medicaid changes coming July 1, 2013 which will require that all physicians who order, prescribe, refer services for Medicaid recipients be enrolled as Medicaid providers. Many providers choose not to accept Medicaid because of funding and timely reimbursement issues. This will effectively cause many of our kids to lose their Medicaid coverage and/or be required to find a new primary care physician that accepts Medicaid! However, if a provider chooses NOT to accept Medicaid they can still enroll as an OPR (Ordering, Prescribing, and Referring) Medicaid provider by registering at the DCH website before April 1, 2013.
Even if you do have a pediatrician who is a Medicaid provider, consider this scenario:
- You go to your child's specialist, who doesn't take Medicaid. He orders a blood test, but it can't be done in his office or Medicaid won't pay for it.
- You have to take the order to your Pediatrician, who re-writes the order.
- However, most general pediatricians don't do blood work in their office, so you have to take the order to LabCorp or Children’s Healthcare of Atlanta to get the test done.
Three different medical offices, just so Medicaid will cover one blood test! Multiply that by every therapy order, prescription, and diagnostic test your child needs, and you can see how this will become a significant issue for many of our clients. Additionally, those who refuse to find a new primary care physician that accepts Medicaid will have to pay for everything out-of-pocket.
Click here for a link to the Georgia Department of Community Health announcement.
Please take a few minutes to call and email your elected officials and let them know how this will affect their constituents. You can find your elected officials by visiting www.votesmart.org. Lastly, please ask your current providers to enroll as an OPR providers at the DCH website BEFORE April 1, 2013.
Here at The George Center, we pride ourselves on finding every way possible for our clients to pay for therapy. Contact us today and we'll see how we can help you find funding for music therapy services!