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advocacy issues
Medicaid advocacy
Medicaid is a state–federal partnership that provides health care to people of all ages—children, pregnant people, working-age adults, individuals with disabilities, and people over age 65. Occupational therapy practitioners work with people who rely on Medicaid for health care across multiple settings, including schools, community mental health centers, skilled nursing facilities, and clients' homes.
Why Medicaid matters
More than 75 million people rely on Medicaid for health care. Medicaid services can ensure that a child with a developmental delay is able to thrive and grow into a self-sufficient adult. Access to Medicaid services can help an adult with a disability live independently in the community, as well as support someone with mental illness to live a healthy life in recovery.
For children, OT services are mandatory under Medicaid's Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. For adults, OT is optional. Most states cover some OT in their standard benefit package and in home and community-based services (HCBS) waiver programs, but eligibility, scope of services, and payment policies vary widely from state to state. AOTA provides resources and support to state advocates working to secure sound coverage and payment policies.
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Related resources
Practice essentials
Medicaid for occupational therapy practitioners
See this AOTA Practice Essentials resource for basics of the Medicaid program's structure and payment policies.
PowerPoint Presentation
Occupational therapy in home and community-based services (HCBS) 1915(c) waivers
This presentation can be used to help build your case for occupational therapy services in HCBS waiver programs.
Case Study
OT in Medicaid-funded HCBS: A provider case study
This resource depicts an OTP working in a day habilitation program providing services to adults with intellectual and developmental disabilities.
AJOT "Health Policy Perspectives" column
Receiving Recognition: A Case for Occupational Therapy Practitioners as Mental and Behavioral Health Providers
One state-level push for Medicaid recognition of occupational therapy practitioners as Qualified Mental Health Providers (QMHPs) and/or Qualified Behavioral Health Providers (QBHPs).
From Medicaid.gov
Contact your state Medicaid agency
Find information about the state agency that administers or supervises administration of your state's Medicaid program.
From KFF
Medicaid expansion
Has your state expanded Medicaid under the Affordable Care Act (ACA)? Explore state Medicaid expansion decisions with this interactive map.