Bridging the Coverage Gap: State Medicaid Limitations for Cardiac Rehabilitation and Risk to Disadvantaged...

Cardiac rehabilitation (CR) is a guideline-supported, evidence-based intervention that improves cardiovascular outcomes, yet access remains inconsistent for Medicaid beneficiaries because coverage policies vary across states.

We evaluated Medicaid reimbursement for outpatient CR services across all 50 U.S. states to identify policy variation that may contribute to inequitable access for vulnerable populations.

A cross-sectional survey review of state Medicaid fee schedules, provider manuals, coverage policies, and direct communication with Medicaid agencies assessed reimbursement for Current Procedural Terminology codes 93797 and 93798. Most states provided coverage, but important geographic variation remained, with several states lacking reimbursement for one or both services. Limited coverage frequently occurred in regions with large Medicaid populations, potentially restricting access to guideline-supported cardiovascular care.

State Medicaid reimbursement policies remain an important determinant of access to outpatient CR. Greater policy consistency may reduce disparities and improve equitable delivery of evidence-based cardiovascular care.