Private Contracts With Medicaid Beneficiaries

Most providers know that fees paid by the New York State Medicaid program are considered to be payment in full. This means that as a requirement of participating with Medicaid, and with the exception of co-payments, providers may not bill Medicaid beneficiaries for covered services. Providers may, however, enter into private pay agreement with Medicaid beneficiaries and the article below addresses certain important aspects of that relationship.

NY Medicaid Beneficiaries & Payments For Services

As mentioned above, Medicaid patients cannot be billed for any additional amounts for a service that has been billed to Medicaid. In addition, providers may not charge Medicaid patients for missed appointments. Without a private pay agreement, providers may not charge Medicaid beneficiaries for services that are not covered by the Program.

Private Pay Agreements

Providers’ private pay arrangements with Medicaid beneficiaries must be entered into before any treatment is rendered for non-covered services and they must be in writing. NY Medicaid also advises providers that they discuss with beneficiaries any alternative treatment plans, the advantages and disadvantages of the treatment, as well as the expense and the full extent of financial responsibility associated with each option. This is particularly important when treatment alternatives exist that may be fully covered by Medicaid without any expense to the beneficiary.

These as well as other important terms must be covered in the private pay agreements between providers and Medicaid beneficiaries. All discussions and agreements between providers and their patients must also be fully documented in the patients’ medical records.

If you have questions about NY Medicaid, private pay agreement with Medicaid beneficiaries, or need other legal assistance please contact us.