Medicaid Prescription Reimbursement: A Guide After Approval

Medicaid is health insurance offered to low-income individuals. Although Medicaid is a federal program, each state has its own guidelines and requirements for eligibility. Prescription coverage is available to recipients. If you are accruing medical bills, including prescription charges while waiting for your application to be approved, Medicaid may reimburse you, depending on the state's policy. Check with your local Medicaid office to determine if your prescription is eligible for reimbursement. If so, you will need to submit a claim to Medicaid.

Step 1

Contact your local Medicaid office (see Resources). Visit the office online or in person to inquire about the proper claim form and procedure to follow. The forms will vary depending on the state and HMO plan. Obtain the address or fax number to submit the claim.

Step 2

Gather receipts. Prepare to supply the receipt for the prescription. You can refer to the prescription bottle for information such the prescription number, name of the drug and the doctor's name.

Step 3

Complete the form. You will be asked your name, Medicaid identification number, date or birth, Social Security number and address. Include the name of the prescription, the doctor's name and the price of the prescription. You will also be asked to provide information about the pharmacy such as the name, address and national provider identification number. Each pharmacy in the United States is assigned a unique identification number to assist with the claims and billing process. Ask the pharmacy for its provider identification number. State the reason the claim is being submitted.

Step 4

Submit the claim. Mail or fax the claim to the appropriate location. Your state's Medicaid processing unit will review the claim to determine if you are eligible for reimbursement. You will receive an answer in the mail stating whether the claim was paid, denied or suspended.