Kaiser Permanente's Medicaid Coverage Varies by State and Region

Kaiser Permanente does accept Medicaid in some states, but not all. The health plan operates in 8 states and Washington D.C., and Medicaid acceptance depends on which state you live in and which Kaiser region serves your area. If you have Medicaid and want to use Kaiser, you need to check whether your specific state's Medicaid program has a contract with Kaiser in your region.

Kaiser does not operate nationwide. It has regional health plans in California, Colorado, Georgia, Hawaii, Maryland, Ohio, Oregon, Virginia, and Washington D.C. Even in states where Kaiser exists, the company may not accept Medicaid in every region or may only accept it through certain Medicaid managed care plans.

Key Takeaways

  • Kaiser Permanente accepts Medicaid in California, Colorado, Georgia, Hawaii, Maryland, Ohio, Oregon, Virginia, and Washington D.C., but coverage varies by region within each state.
  • You must contact Kaiser directly or your state Medicaid agency to confirm whether Kaiser participates in your area's Medicaid managed care plans.
  • If Kaiser does not accept Medicaid in your region, your state Medicaid program will direct you to health plans that do operate there.
  • Kaiser's Medicaid plans typically work the same way as their commercial plans — you choose an in-network primary care doctor and need referrals for specialists.

Which States Have Kaiser Medicaid Plans

Kaiser Permanente operates Medicaid managed care plans in the following states: California (multiple regions), Colorado, Georgia, Hawaii, Maryland, Ohio, Oregon, Virginia, and Washington D.C. However, Kaiser does not serve every county or city within these states. For example, Kaiser in California has strong presence in Northern California and Southern California but does not cover all inland regions.

In states like Georgia and Virginia, Kaiser Medicaid plans may only be available in certain metropolitan areas. If you live in a rural part of a state where Kaiser operates, the company may not serve your county. Your state Medicaid agency's website will show you which health plans, including Kaiser if available, operate in your specific zip code or county.

How to Check If Kaiser Accepts Medicaid Where You Live

Start by contacting your state Medicaid agency directly. Most state Medicaid programs have a website or phone line where you can enter your zip code and see which managed care plans are available in your area. If Kaiser appears on that list, it means Kaiser has a contract to serve Medicaid members in your region.

You can also call Kaiser Permanente's member services line for your region and ask whether they accept Medicaid. Have your Medicaid card or case number ready. Kaiser's regional phone numbers are listed on their website by state. If Kaiser does not serve your area, the state Medicaid agency will tell you which plans do and can walk you through how to choose one.

What Happens If Kaiser Does Not Accept Medicaid in Your Area

If Kaiser does not operate in your region or does not accept Medicaid there, you will need to choose from the health plans your state Medicaid program does offer. Your state will provide a list of available managed care plans, and you can pick one during open enrollment or when you first become Medicaid-may be able to access. Some states assign you to a plan automatically if you do not choose within a certain timeframe.

The other health plans available in your area will work similarly to Kaiser — you will have a primary care doctor, pay little to no premium, and use in-network providers. Your state Medicaid agency can help you compare plans and understand the differences between them.

How Kaiser Medicaid Plans Work

If Kaiser accepts Medicaid in your area, you can enroll in a Kaiser Medicaid managed care plan. Once enrolled, you will choose or be assigned a primary care doctor within Kaiser's network. Your primary care doctor coordinates your care and provides referrals if you need to see a specialist. Most routine care, preventive services, and emergency care are covered with little or no out-of-pocket cost.

Kaiser Medicaid plans require you to use Kaiser doctors and facilities for most care. If you go to a provider outside Kaiser's network without a referral, you may have to pay out of pocket or the service may not be covered. Some plans allow out-of-network emergency care, but you should confirm this with Kaiser before you need it.

Documents and Information You Need to Enroll

To enroll in a Kaiser Medicaid plan, you will need to provide your Medicaid case number or identification number. You may also need to provide proof of residency in the Kaiser service area, such as a utility bill or lease. Kaiser will ask for basic information like your name, date of birth, and contact details.

If you are already Medicaid-may be able to access and your state offers Kaiser as an option, you can enroll during open enrollment periods or when you first become may be able to access. Some states allow you to switch plans once a year; others allow switches only during specific enrollment windows. Check with your state Medicaid agency about when you can enroll or change plans.

Frequently Asked Questions

Can I use Kaiser if I have Medicaid and Medicare at the same time?

Kaiser does offer some dual-may be able to access plans in certain states for people with both Medicaid and Medicare. However, availability is limited and varies by state and region. Contact Kaiser directly or your state Medicaid agency to ask whether a dual plan is available where you live.

What if I move to a different state or region where Kaiser does not accept Medicaid?

If you move, you will need to disenroll from your Kaiser Medicaid plan and choose a new plan in your new state or region. A move is usually considered a may have access to life event, so you can change plans outside the normal open enrollment period. Contact your state Medicaid agency in your new location to see which plans are available.

Do I have to pay a premium for Kaiser Medicaid?

Most Medicaid members pay no premium for their health plan. However, some states charge small premiums for certain Medicaid groups or plans. Check your Medicaid notice or contact your state Medicaid agency to confirm whether your plan has a premium.

How do I find Kaiser's phone number for my state?

Kaiser Permanente's website lists regional phone numbers by state. You can also call your state Medicaid agency and ask for Kaiser's member services number for your area. Your Medicaid card may also have Kaiser's number on it if you are already enrolled.