Medicaid Coverage for Podiatric Care: A National Survey

Abstract

Objectives: Medicaid provides health insurance for low-income people meeting specific eligibility requirements. It is funded and administered by both the federal and state governments; this decentralization leads to vastly different programs across the country. The objective of this legal surveillance project was to describe state-by-state differences in podiatric care coverage for nonelderly adults across Medicaid programs. Methods: We used policy surveillance, a form of advanced legal mapping. It is the systematic collection and analysis of written policies across jurisdictions. Policy surveillance captures the important features of law through a rigorous scientific process to turn these policies into structured, quantitative legal data that are suitable for further evaluation or modeling. Data for the 51 jurisdictions were current as of September 1, 2020. Results: The vast majority of jurisdictions (82%) covered podiatric services for all classes of Medicaid beneficiaries, but the rules, restrictions, and limitations around coverage differed. Twenty-five jurisdictions had no limits on the number of podiatric visits during a specified period; 26 jurisdictions indicated a cap. Ten jurisdictions had no explicit limitations on coverage of routine foot care, whereas 33 jurisdictions covered routine foot care only when medically necessary or with a triggering condition. Eight jurisdictions did not cover routine foot care at all, and 28 jurisdictions required prior authorizations. Conclusions: Podiatric care coverage, which is often preventive, varies greatly by state. This variability in coverage, which has not been previously tracked at the level of detail provided in our study, has implications for cost and health outcomes. The value of podiatric care is especially apparent in Medicaid populations. The compilation of these data can serve as a valuable resource for clinicians, researchers, and policy makers.

Foot and Ankle Care by Podiatrists and Amputations in Patients With Diabetes and Kidney Failure

“…Previous studies have highlighted wide variations in routine preventive podiatry care coverage across insurance types, states, and even within states depending on Medicaid Advantage–Managed Care programs. 30 , 31 Addressing these challenges and the policy implications of expanded coverage are beyond this article’s scope, requiring further comprehensive studies. An understanding of the underlying patient-level and health care system–level factors that contribute to this gap can guide the development of targeted interventions to ensure more individuals at risk for DFUs receive appropriate preemptive foot and ankle care.…”