What is the difference between Fee-for-Service Medicaid and Medicaid Managed Care?

There are two kinds of Medicaid:

  • Regular Fee-for-Service Medicaid
    • With fee-for-service Medicaid, you can go to any doctor, hospital, or clinic that takes Medicaid. The doctor bills Medicaid and Medicaid pays the bill.
  • Medicaid Managed Care
    • With Medicaid Managed Care, you join a health plan that is in charge of your medical care. With Medicaid managed care there are rules about which doctors you can see and how you get care.
      • You have a primary doctor. When you join a managed care plan you pick a doctor from your plan’s list. This doctor, known as your Primary Care Provider (PCP), will be in charge of your care. This doctor will give you regular care, like routine check-ups and shots. Try to get to know your Primary Care Provider. This doctor should know your medical history and your health care needs. This doctor will also be the one to refer you to see other types of doctors.
      • Your doctors must be on the managed care plan’s list. Your managed care plan will only pay doctors, hospitals, and other health care providers that are on the plan’s list. However, your plan will pay for out of network providers if you were seen in an Emergency Room due to an Emergency Medical Condition or for other special reasons.
      • You must get permission to see other doctors. You must ask your Primary Care Provider for permission, or a “referral,” to see a specialist or to go into the hospital, unless you have an emergency