Does Medicaid Pay for Hip Replacement Surgery?
Medicaid is a government-funded health care program created under Title XIX of the 1965 Social Security Act for elderly, disabled and other qualifying low-income individuals. Hip replacement surgery is sometimes covered under Medicaid.
Prior Authorization
Medicaid requires a prior authorization before they will pay for hip replacement surgery. A primary care physician must refer a patient to a specialist, who must then complete documentation that hip replacement surgery is necessary.
After Care
In-home health services, meals delivered to the home, and other assistance with daily living activities will likely be necessary for an individual after hip replacement surgery. Medicaid will cover the cost of these services under certain circumstances. Contact your state Medicaid office to discover what services are covered under which circumstances; coverage varies among state Medicaid programs.
Appeal
If Medicaid does not authorize payment for hip replacement surgery, you have the right to appeal. Contact your state Medicaid office to obtain directions for file an appeal; the process and forms vary among state Medicaid programs.
Mistakes
Medicaid will not pay for correction of physician errors made during or after hip replacement surgery. However, physicians should be held responsible for correcting any error; otherwise they could be held liable in civil court.
Dual Eligibility
If you are eligible for both Medicare and Medicaid, Medicare will pay a portion of your hip replacement surgery costs and Medicaid will typically pay the remaining portion. Call 1-800-MEDICARE if you have Original Medicare; if you have Medicare Advantage, contact your plan provider to discuss what types of coverage are available for your hip replacement surgery.
