Medicaid Coverage for Podiatric Care: A National Survey

Area of Science:

• Health Policy
• Legal Epidemiology
• Public Health

Background:

• Medicaid is a crucial health insurance program for low-income individuals in the U.S.
• Federal and state governments jointly fund and administer Medicaid, resulting in program variations.
• Podiatric care is essential for preventive health and managing conditions, particularly in vulnerable populations.

Purpose of the Study:

• To systematically analyze and compare state-specific Medicaid coverage policies for podiatric care among nonelderly adults.
• To identify and quantify variations in coverage rules, visit limitations, and routine foot care policies across U.S. states.
• To establish a data resource for understanding the landscape of podiatric care access within state Medicaid programs.

Main Methods:

• Employed policy surveillance, a method for systematic legal mapping and data collection.
• Analyzed written policies from all 51 U.S. jurisdictions as of September 1, 2020.
• Transformed legal policies into structured, quantitative data for comparative analysis.

Main Results:

• 82% of jurisdictions covered podiatric services for all Medicaid beneficiaries, but with diverse restrictions.
• Significant variation exists in visit limitations (25 no limits, 26 capped) and routine foot care coverage (10 no limits, 33 medically necessary, 8 none).
• Prior authorization was required in 28 jurisdictions, highlighting administrative hurdles to accessing care.

Conclusions:

• State-level variations in Medicaid podiatric care coverage are substantial and previously unquantified.
• These coverage disparities have potential implications for healthcare costs and patient health outcomes.
• The compiled data serve as a vital resource for clinicians, researchers, and policymakers to address access gaps.