Navigating Medicaid: How small healthcare providers in Alaska work with Medicaid to deliver vital services.

• Author: Newman, Amy

Medicaid was enacted by the federal government in 1965 to pay for certain healthcare services for low-income families with dependent children and the aged, blind, and disabled. Though federally mandated, states share the cost of the program with the federal government, and each state creates and manages its own Medicaid plan, subject to federal approval.

Over time the program has grown to include more than fifty mandatory and optional eligibility groups; Medicaid expansion in 2015 further increased the number of Alaskans eligible for Medicaid. According to the Alaska Department of Health and Social Services, which administers the state plan, Alaska's Medicaid program covers more than 200,000 men, women, and children, providing access to healthcare services they couldn't otherwise afford.

Healthcare providers aren't required to accept Medicaid and for small businesses, the idea of dealing with the bureaucratic red tape that often accompanies government programs can make it seem like an unattractive option. And while some of those concerns are valid, they aren't insurmountable.

"When you've got good front office staff, it's not that terrible," says Heidi Bennetts, chief administrative warrior at Alchemy Orthotics & Prosthetics in Anchorage. "You just have to have someone in that front seat who has a backbone and is kind and capable of directing people in the right direction and eloquently explaining what the rules are."

Becoming a Medicaid Provider

Healthcare providers and facilities that want to become an authorized Medicaid provider must apply through the state's online provider portal. There are no prohibitions on who can accept Medicaid, so long as providers offer a covered service and can produce the required documentation.

"If there's a service that's covered, then any willing provider who enrolls can provide that service," explains Monique Martin, director of government relations and regulatory navigation at Alaska Regional Hospital.

Some documents, like a National Provider Identifier, current business license, proof of malpractice insurance, and proof of professional licenses, are required of all providers. Other information, like certifications or accreditations, are specific to each practice area. None of it, though, is that different from what's necessary to become a preferred provider for any other insurance company.

"For credentialing it's not any different than getting into a [preferred provider organization]," says Cathy...