Does Medicaid Pay For Chiropractor Services?

Last Updated on January 25, 2024 by Lori Pace

I recognize the perplexity many face when assessing the breadth of Medicaid’s support for chiropractors. The question often echoed is, ‘Does Medicaid Pay For Chiropractors?’. And while the answer may seem elusive, it’s important to know that the coverage landscape hinges on your state of residence. Each state tailors its own eligibility standards for chiropractic care.

As I’ve immersed myself in the intricacies of Medicaid’s state-oriented structure, it’s clear that state laws hold significant sway over the program’s operations. The US acknowledges the mounting relevance of chiropractic care, as evidenced by the surge in spinal-related issues. Moreover, a notable aspect emerges in Medicaid’s strategic cost containment. By offering coverage even before conditions turn severe, Medicaid curtails the need for last-minute interventions, pain relief medications, or even emergency room visits.

What Is Chiropractic Care?

As someone who has experienced firsthand the transformative effects of chiropractic care, let’s delve into the mechanics. Picture a skilled chiropractor gently applying controlled force to spinal joints using their hands. This meticulous process isn’t just about adjusting bones; it’s about restoring spinal mobility and optimizing the body’s natural function.

Therapist, Chiropractor
Chiropractic care involves a doctor or chiropractor applying a controlled force to a spine joint using their hands

Chiropractic care believes that alignment of the spine will allow the body to heal itself naturally without the need for drugs or surgery. Manipulation can restore movement to damaged joints due to traumatic events like sitting without back support.

Chiropractors primarily use this technique to relieve pain in the bones, muscles, joints, and connective tissues such as ligaments, tendons, and cartilage.

Who Qualifies for Chiropractic Care Under Medicaid?

You must show your Medicaid ID card to receive any Medicaid services because this ID card serves to confirm your eligibility for the particular Medicaid healthcare service. Who is eligible for chiropractic care under Medicaid

  1. Chiropractic care is a mandatory benefit for Medicaid recipients who have EPSDT (Early Periodic Screening Diagnosis Treatment). This applies to pregnant women in the third trimester and children six years or older.
  2. Drawing from my insights into Medicaid intricacies, it’s worth noting that individuals aged 21 and above can access chiropractic care from Medicaid-approved practitioners. An important caveat: Medicaid’s coverage is capped at one treatment per individual per day, underscoring the program’s emphasis on ensuring judicious utilization.

Which Chiropractic Care Services Does Medicaid Cover?

Having navigated the intricacies of Medicaid’s healthcare provisions, it’s evident that chiropractic care finds its place when deemed medically necessary. These essential services encompass a range of examinations and diagnoses designed to positively impact the neurophysiological function within the intricate web of the spine.

Medicaid covers these chiropractic services:

Chronic Back Pain

If you are suffering from chronic back pain, chiropractic care may be the best option. There are many chiropractic treatments that can help you manage chronic back pain, such as a herniated disk.

MSD (musculoskeletal disorders) is a condition that chiropractors can diagnose and treat. They will also recommend a treatment plan and refer you to a specialist, such as a surgeon. Spinal manipulation and spinal mobilization are two of the many treatments that Medicaid covers for chronic back pain.

Neck pain

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Neck pain is often caused by poor posture, age-related wear, and poor sitting and sleeping habits.

So, chiropractic neck adjustments, or cervical spine manipulation, is a procedure that aims to loosen the cervical vertebrae’s joints. As a result, this can reduce the pain from muscle spasms and pinched nerves.

Spinal X-Rays

Medicaid covers spinal X-rays if the procedure is medically necessary. The procedure can only be done on one side and the end of the entire spine.

To qualify for Medicaid reimbursement of your spinal x-ray, you must meet at least one condition:

  1. Present severe or intense trauma, where there may be a concern with fracture, avulsion spinal subluxation.
  2. Chronic or pre-existing conditions that qualified doctors have not treated.
  3. If there is a suspected malignancy or other pathology, it can be covered with precautionary spinal radiographs.
  4. A patient should be diagnosed if they have a sign of an existing malignancy.
  5. A patient who has had long-term spinal therapy with no decrease in symptoms.

Which Chiropractic Care Services Doesn’t Medicaid Cover?

Medicaid will not pay for other services if it’s not those listed above unless approved by Medicaid.

Do You Need Prior Authorization for Medicaid to Pay For Your Chiropractors?

In the realm of Medicaid’s chiropractic care, a vital aspect surfaces: individuals with Medicaid coverage are typically entitled to 12 chiropractic visits each year. Any additional visits extended beyond this limit would necessitate written authorization from your local Medicaid office. Worth noting, if you’ve already obtained prior authorization from a local clinic, Medicaid coverage won’t apply. However, exceptions come into play if specific documentation validates the necessity of care, particularly in cases of urgency or retro-eligibility.

Retroactive eligibility refers to a period of three consecutive months preceding the month in which patients fill the Medicaid request. This is when you are eligible for Medicaid coverage, as determined by your local Medicaid office.

Please note, however, that Medicaid will not pay for services rendered if it exceeds the time frame stated in the prior authorization document.

Does Medicaid Pay For Chiropractors? Yes, But…

For those grappling with persistent neck and back discomfort, it’s reassuring to know that chiropractic solutions could be within reach. Medicaid’s coverage, though nuanced, holds the potential to encompass such treatments, contingent on your geographical location. Remarkably, chiropractic care emerges as a mandated Medicaid benefit, catering to pregnant mothers in their final trimester and children aged six or below. Curious about whether your specific plan embraces chiropractic care? A quick inquiry can provide the clarity you seek.

However, if you have a Medicare Insurance plan, does Medicare cover chiropractic care?

Lori Pace
Lori Pace

Lori Pace is a single mother of three daughters ages 7 and under. As a working mom from home, she balances kids, work and two crazy dogs with humor and love. Follow Lori as she honestly gives tips and advice based on her own experiences as a single mom!