Medicaid and Other Payers
Medicaid interacts with other payers when Medicaid beneficiaries have other sources that are legally liable for payment of their medical costs. These may include private insurance, Medicare, other public programs such as the Ryan White program, workers’ compensation, and amounts received for injuries in liability cases. The program also interacts with CHIP when states provide Medicaid coverage to beneficiaries using CHIP funds.
Learn More about These Topics
Featured Publications
State Medicaid Payment Policies for Medicare Cost Sharing
August 25, 2025
A new compendium and related Policy in Brief from MACPAC provides state-level information on Medicare crossover policies for inpatient hospital services, outpatient hospital services, nursing facility services, and physician services as of May 2025. It finds that most states have lesser of policies, with slight variation across service types.
Medicaid Coverage Based on Medicare National Coverage Determination: Moving Towards Recommendations
January 23, 2023
Under Medicare Part B, the Centers for Medicare & Medicaid (CMS) Services has the authority to make a national coverage determination (NCD) on whether a service or prescription drug is reasonable and necessary. Under certain circumstances, CMS can link coverage of an item or service to participation in an approved clinical study or to the […]
Transitions in Coverage Between Medicaid and Other Insurance Affordability Programs
December 8, 2022
This session examined policy issues that affect the ability of beneficiaries who are losing Medicaid eligibility to smoothly transition to other insurance affordability programs, including the State Children’s Health Insurance Program, the Basic Health Program, and subsidized exchange coverage. This work follows up on MACPAC’s previous work examining transitions between coverage sources before the COVID-19 […]