Note: The Department of Social and Health Services (the Department) provides funding for a wide range of medical services. The level of medical coverage for any given client depends on the Medical Program for which the client is eligible. This table lists services that may be provided under the specific services/programs if the individual meets all the criteria required to receive the service. Some services may require prior authorization from the Department or a Department-contracted managed care plan. This table is provided for general information only and does not in any way guarantee that any service will actually be covered. Benefits, coverage, and interpretation of benefits and coverage may change at any time. Coverage limitations can be found in federal statutes & regulations, state statutes & regulations, state budget provisions, and Department billing instructions and numbered memoranda. Clients with questions regarding coverage may call the 800 number on the back of their Services Card.
- Alien Medical Programs
- Alien Emergency Medical (AEM)
The Department covers services only necessary to treat the client's emergency medical condition.
- Alien Medical for Dialysis and Cancer Treatment (state funded)
The Department covers services only necessary to treat the client's end stage renal disease or cancer.
- Alien Nursing Facility Program (state funded)
The Department covers services necessary facility care for clients under very limited conditions.
- QMB Medicare Only
The Department covers on the Medicare coinsurance and deductible up to the Medicare or the Department allowed amount, whichever is less.
- Non Emergency Medical Transportation (Brokered Transport)
The Department covers non emergency medical transportation for eligible clients to or from covered services through contracted brokers. The brokers arrange and pay for trips for qualifying Department/MPA clients. Currently, eligible clients include Medicaid, S-CHIP, AHFC, GA, ADATSA, and AEM.
- Interpreter Services - Spoken Languages
The Department covers the cost of interpreter service for eligible clients through contracted brokers. Requests for spoken language interpreter services must be requested by Medicaid providers or authorized Department staff.
- Interpreter Services - Sign Language
The Department covers the cost of sign language services for eligible clients. Requests for sign language interpreter services must be requested by Medicaid providers or authorized Department staff and provided by Department-approved contractors.
- Psychiatric Indigent Inpatient (PII) Program
The Department covers voluntary psychiatric inpatient care for clients eligible under the PII program.
Customer Service Phone Numbers
Department clients may call 1-800-562-3022 (option 6) for more information.
Providers may call 1-800-562-3022 (option 5) for more information.
Medical Assistance Billing Instructions
ADATSA - Alcohol and Drug Abuse Treatment and Support Act
AHFK - Apple Health for Kids
CN - Categorically Needy Program
FP/TC - Family Planning Only/TAKE CHARGE
MN - Medically Needy Program
CHIP - Children's Health Insurance Program