Medicaid Rules

As of 2026, under Medicaid rules, if a client is an Medicaid member and the service is covered, the provider generally cannot bill the client for that service, and Medicaid is treated as the payer of last resort. Medicaid rules also require providers to bill Medicaid or the managed care plan when applicable, even when Medicaid is secondary, and the provider must be enrolled/credentialed to bill Medicaid for covered services.

Why we can’t accept Medicaid clients

Because we have not pursued Medicaid credentialing, we are not enrolled to bill Medicaid or its contracted plans for covered services. Medicaid guidance on out-of-network providers states that these providers must be credentialed and must meet contracting and re-credentialing requirements, including compliance checks.

Why secondary Medicaid still matters

Medicaid as a secondary plan does not remove the enrollment requirement. Medicaid guidance for Medicaid crossover billing states that when Medicaid is the secondary payer, the provider enrollment requirement still applies, and the provider must be properly enrolled for the claim to be processed. In other words, even if another insurer is primary, Medicaid still cannot simply be ignored if it is a payer on the case.