Does Medicaid Cover Physical Therapy in 2023
Physical therapy helps effectively treat disease, injury, or deformity using such modalities as massage, heat treatment, exercise, etc.
It helps improve or restore patients' mobility, relieve pain and reduce the need for surgery and prescription drugs. Physical therapy is a crucial part of treatment for patients with chronic conditions, illnesses, or injuries and rehabilitation as well as preventive care.
While many people can benefit immensely from physical therapy, one of the most common and pressing questions is its costs, affordability, and coverage by health insurance programs. So today, we're diving deep into this topic, answering everything about your commonly asked question - "does Medicaid cover physical therapy?".
Does Medicaid Cover Physical Therapy in 2023?
It's essential to establish that there is no one answer to this complex question because Medicaid benefits depend on the state you live in, independently from the federal government, which means you need to check the exact information for your state to get the complete picture. You can find a table listing all the states here.
States have their own Medicaid programs. In these programs, they determine the type and scope of services patients can expect to be covered.
These include inpatient and outpatient hospital services, physician services, laboratory and x-ray services, home health services, and certain optional benefits you'll find such services as case management, physical therapy, and occupational therapy.
Since Medicaid benefits are governed state-by-state, their coverage of inpatient, outpatient, and at-home physical therapy may differ. Get in touch with your Medicaid office to understand what is covered in your insurance plan.
Many people ask us, how many physical therapy sessions does Medicaid cover? Overall, different states will cover a different number of sessions, with some offering 30 and more and others capping at 20 or fewer sessions per year. Some states have no limitations, and you can receive as many treatment sessions as needed.
Benefits of Physical Therapy
Physical therapy is beneficial in treating various illnesses, ailments, and conditions, from stroke and injury to trauma and arthritis. It helps reduce the symptoms of many chronic diseases and can help prevent many problems from worsening.
Physical therapy can help relieve pain, improve mobility, and range of motion, recover from traumas and injuries, reduce the need for medication, and improve patients' well-being overall.
Physical therapists (PTs) also teach their patients how to use physical therapy in their everyday lives, including stretches, exercises, and particular movements that can help with such tasks as climbing the stairs or getting out of the bathtub.
Lastly, physical therapy professionals assess each patient and create in-depth treatment plans to achieve recovery goals. They then track those goals and healing progress to ensure the best outcomes.
Physical Therapy helps:
Reduce or eliminate pain
Avoid and recover from surgery
Improve mobility and range of motion
Recover from or prevent a sports injury.
Recover from a stroke
Recover from accidents and traumas
Improve balance and prevent falls.
Manage diabetes and vascular conditions.
Prevent illness or condition from getting worse.
Manage age-related issues
Manage heart and lung disease.
Manage Women's Health
What Is Medicaid?
Medicaid is the national public health insurance assistance program for low-income people, families, children, pregnant women, the elderly, and people with disabilities.
Today, Medicaid covers over 17% of U.S. healthcare spending and assists more than 75 million Americans.
So does Medicaid pay for physical therapy? This depends on the terms and conditions of insurance that vary from state to state. Within specific federal regulations, each state administers its own Medicaid program and establishes its own eligibility standards, payment rates, the type, amount, duration, and scope of services.
Often physical therapist services are an optional benefit in many states, and there's also a chance that state programs work with third-party administrators to manage and review physical therapy services.
Is Physical Therapy Covered by Medicaid?
Get in touch with your Medicaid office to understand what is covered in your insurance plan.
When Does Medicaid Pay for Physical Therapy?
If physical therapy is covered in your state's Medicaid program, it usually reimburses for physical therapy services that include castings and strappings, evaluations, and treatments.
To get your physical therapy covered by Medicaid, you need a referral from your primary physician. The treatment should be performed by a qualified professional who has to establish and fulfill a program to improve or maintain your condition.
This means you need to talk to your primary physician and discuss getting a referral issued in writing, where they explain that it is necessary for you to visit another health care provider for treatment. Keep in mind that in some states and in some cases, you may need prior authorization for this referral. After reviewing the case, this authorization is issued by your Medicaid provider and sometimes Rehabilitative services and Specialized care.
Depending on the state, such services may be performed as an inpatient and outpatient as well as in-home if the patient cannot travel.
Other Possible Conditions For PT Coverage
Medicaid recipients 18 years or older and in a Long-Term Care or Comprehensive Long-Term Care plan may receive physical therapy.
Recipients 20 years of age or younger and not in a long-term care plan may receive physical therapy services under the coverage and limitations policy.
Recipients 21 years of age and older may receive limited wheelchair evaluations and fittings services.
Medicaid Physical Therapy Coverage
Make sure you get detailed information from your local Medicaid office to avoid misunderstandings.
Medicaid Coverage for Physical Therapy in Michigan in 2023
Let's briefly discuss Medicaid eligibility for physical therapy in Michigan in 2023. In the state of Michigan, Medicaid and MIChild cover medically necessary services, including physical and occupational therapy.
Medicaid coverage for physical therapy is covered for the categorically needy, there's no copay, and patients get 144 units of service per year without PA.
In Michigan, the practice of physical therapy means the evaluation of, education of, consultation with, or treatment of an individual by the employment of effective properties of physical measures and the use of therapeutic exercises and rehabilitative procedures, with or without assistive devices, to prevent, correct, or alleviating a physical or mental disability.
Physical measures include massage, mobilization, heat, cold, air, light, water, electricity, and sound.
Medicaid in Michigan
Medicaid and MIChild cover medically necessary services, among which are physical therapy services.
hearing and speech services
home health care
inpatient and outpatient hospital care
medicine prescribed by a doctor
mental health services
non-emergency medical transportation
nursing home care
personal care services
physical and occupational therapy
podiatry (foot care)
pregnancy care (prenatal, delivery, and post-partum)
private duty nursing
substance use disorder treatment services
However, we encourage you to contact your local Medicaid office to determine eligibility for physical therapy.
FAQs About Medicaid Physical Therapy Coverage
Does Medicaid Cover Physical Therapy at Home?
Most people get their physical therapy treatment at the PT's office or facility. However, some people are not able to leave the house due to illness or other reasons. In these cases, home physical therapy may be covered by Medicaid, depending on the state.
It will be up to your primary physician to determine whether you're unable to leave your home without help, and then they will recommend physical therapy at home. This can include cases when it's physically too difficult to travel, or you have a serious medical condition.
How Many Physical Therapy Sessions Does Medicaid Cover?
Depending on the state, the number of therapy sessions may vary. Some states will offer 20-30 sessions per year; others, like the state of Michigan, will offer 144 units of service per year without PA.
A service unit is a patient visit or a procedure and measures service volume over a certain period of time.
In general, patients have at least a few visits with the physical therapist; how many exactly depends on the individual's needs and progress. On average, 6 to 12 visits is enough to cover most cases and diagnoses.
Your therapist will most likely recommend three visits per week; however, with time, you may need one or two visits only, depending on your progress.
The length of a visit usually depends on the injury or condition; overall, patients can expect a session to last between 45 and 75 minutes. The first session is usually longer as it includes an assessment.
Can Medicaid Deny Physical Therapy?
Yes, Medicaid can deny physical therapy. However, if you are in the Medicaid program and your state Medicaid agency or organization denies it, you have the right to appeal.
Every state's Medicaid program is different, but states must have appeal hearings for Medicaid recipients who are denied services. To continue to receive benefits, you need to be vigilant as you may only have 10 days to file to submit your appeal.
Does Medicaid Need a Referral to Pay for Physical Therapy?
Yes, for Medicaid to cover your physical therapy treatment, you need a referral or prescription from a physician (e.g., your primary care physician).
To sum up, you can use Medicaid to cover your physical therapy if you fall under the categories that are described. You can consult Medicaid support to know if the particular service you are looking for is covered by their services.
Otherwise, you can book an appointment with Miracle Rehab Clinic in one of their many locations across the Michigan state and explain your situation. Our professionals will be glad to help and answer your questions.
Remember, prioritize your physical and mental health above anything else.