Medicaid for the Plastic and Reconstructive Surgeon

• Published in: Plastic and reconstructive surgery (1963)
• Main Authors: Firouzbakht, Peter K, Shaum, Katherine M, Israel, Jacqueline S, Rao, Venkat K
• Format: Journal Article
• Language: English
• Published: United States 01.03.2020
• ISSN: 1529-4242
• DOI: 10.1097/PRS.0000000000006560

Medicaid is a complex federally and state funded health insurance program in the United States that insures an estimated 76 million individuals, approximately 20% of the United States population. Many physicians may not receive formal training or education to help understand the complexities of Medicaid. Plastic surgeons, residents, and advanced practice practitioners benefit from a basic understanding of Medicaid, eligibility requirements, reimbursement methods, and upcoming healthcare trends. Medicaid is implemented by states with certain federal guidelines. Eligibility varies from state to state (in many states linked to the Federal Poverty Level (FPL)), and is based on financial and non-financial criteria. The passage of the Affordable Care Act in 2010 permitted states to increase the FPL eligibility cutoff to expand coverage for low-income adults. The aim of this review is to provide a brief history of Medicaid, explain the basics of eligibility and changes invoked by the Affordable Care Act, and describe how federal insurance programs relate to plastic surgery, both at academic institutions and in community practice environments.