Kaiser's Medicaid acceptance varies by state and plan type

Kaiser Permanente does accept Medicaid in some states, but not all, and the details depend on where you live and which Kaiser region serves your area. Kaiser operates as a regional health system — it does not have a national Medicaid contract. In states where Kaiser does take Medicaid, you typically enroll through your state's Medicaid program, and Kaiser becomes your health plan and provider network combined.

The states where Kaiser currently accepts Medicaid include California, Colorado, Georgia, Hawaii, Maryland, Ohio, Oregon, Virginia, and Washington. However, this list changes, and within each state, Kaiser may only serve certain counties or regions. Even in states where Kaiser takes Medicaid, not all Medicaid plans offered by the state go through Kaiser — your state may offer multiple managed care plans, and Kaiser is one option among them.

If you live in a state not listed above, Kaiser does not currently accept Medicaid. In that case, you would need to enroll in a different Medicaid managed care plan or fee-for-service Medicaid offered by your state.

Key Takeaways

  • Kaiser accepts Medicaid in nine states: California, Colorado, Georgia, Hawaii, Maryland, Ohio, Oregon, Virginia, and Washington, though coverage is not available in all counties within those states.
  • You enroll in Kaiser Medicaid through your state's Medicaid program during open enrollment or when you first become Medicaid-may be able to access, not directly through Kaiser.
  • Kaiser Medicaid plans typically include both your health insurance and access to Kaiser's doctors and hospitals in one package.
  • If Kaiser does not serve your state or county, your state Medicaid program will show you other managed care plans you can choose from.

How to learn about Kaiser takes Medicaid in your area

Start by contacting your state Medicaid agency directly. Your state's website lists all managed care plans available to you, including whether Kaiser is one of them. You can also call your state's Medicaid customer service line — the number is on your Medicaid card or on your state's Medicaid website.

When you call, tell them you want to know which health plans are offered in your county. They will tell you the names of all available plans and whether Kaiser is among them. If Kaiser is available, ask them to send you the plan documents or direct you to where you can read the plan details online, including which doctors and hospitals are in the network.

You can also visit Kaiser's website and use their plan finder tool, which asks for your state and zip code. However, the state Medicaid agency is the official source — they know exactly which plans are active in your area and when enrollment periods open.

What happens when you enroll in Kaiser Medicaid

Once you enroll in a Kaiser Medicaid plan through your state, Kaiser becomes both your insurance company and your primary care network. This means your doctor visits, hospital care, prescriptions, and most other services all go through Kaiser's system. You do not receive a separate insurance card from another company — Kaiser is your Medicaid plan.

You will receive a Kaiser Medicaid member ID card in the mail. When you go to a Kaiser facility or see a Kaiser doctor, you show this card. Copays and cost-sharing (if any) depend on your specific plan and your state's Medicaid rules — some Medicaid plans have no copays, while others charge small amounts per visit.

If you need a doctor outside the Kaiser network, you typically must get a referral first, and out-of-network care may not be covered except in emergencies. This is different from some other Medicaid plans that allow you to see any Medicaid provider without a referral.

Differences between Kaiser Medicaid and Kaiser commercial insurance

Kaiser Medicaid and Kaiser commercial insurance (the kind you get through an employer) use the same doctors and hospitals, but the plans themselves are different. Medicaid plans have lower or no copays, cover more preventive services without cost-sharing, and follow your state's Medicaid rules. Commercial plans typically have higher copays and deductibles but may offer more flexibility in choosing specialists.

If you have both Medicaid and commercial insurance (called dual coverage), Kaiser will coordinate the benefits. Medicaid pays first, then the commercial plan may cover what Medicaid does not. You should tell Kaiser about both plans when you enroll so they can process claims correctly.

What to do if Kaiser Medicaid is not available in your state

If Kaiser does not take Medicaid where you live, your state Medicaid program will show you other managed care plans during enrollment. These plans work similarly to Kaiser Medicaid — you enroll through your state, receive a member card, and use that plan's network of doctors and hospitals.

You can also ask your state Medicaid agency whether fee-for-service Medicaid is an option. Fee-for-service means you can see any doctor or hospital that accepts Medicaid, without being locked into one network. However, fee-for-service Medicaid is less common now; most states have moved to managed care plans.

If you have a Kaiser doctor you want to keep seeing, ask them whether they accept Medicaid outside of Kaiser's plan. Some individual doctors do, though this is rare. Your state Medicaid agency can tell you which doctors in your area accept Medicaid.

Changes to Kaiser's Medicaid plans

Kaiser's Medicaid presence has changed over time. In some years, Kaiser has expanded into new states or counties; in other years, they have reduced their Medicaid offerings. If you are currently enrolled in Kaiser Medicaid, your state will notify you if Kaiser stops offering plans in your area — you will have a grace period to choose a different plan.

Before you enroll in any Kaiser Medicaid plan, read the plan documents to understand what is covered, which doctors are in the network, and what your copays will be. Plans can change from year to year, so check the details each time open enrollment happens (usually once a year in your state).

Frequently Asked Questions

Can I switch from Kaiser Medicaid to a different plan mid-year?

Most states only allow plan changes during open enrollment, which is usually once a year. However, if you have a may have access to life event — such as moving to a new county, losing other insurance, or having a baby — you may be able to change plans outside of open enrollment. Contact your state Medicaid agency to ask whether your situation qualifies.

Do I need a referral to see a specialist in Kaiser Medicaid?

Yes, most Kaiser Medicaid plans require you to get a referral from your primary care doctor before seeing a specialist. This is part of how Kaiser manages care. Your primary care doctor can usually submit the referral electronically, and you can schedule the specialist visit once it is approved.

What if I move to a different state while enrolled in Kaiser Medicaid?

Your Kaiser Medicaid coverage ends when you move out of state, because Kaiser only operates in specific states. You will need to enroll in your new state's Medicaid program and choose a plan offered there. Contact your new state's Medicaid agency as soon as you move to find out how to enroll.

Does Kaiser Medicaid cover dental and vision care?

Dental and vision coverage varies by state and by specific plan. Some Kaiser Medicaid plans include dental and vision; others do not. Check your plan documents or call Kaiser's member services to find out what is covered under your plan.

What if Kaiser stops offering Medicaid in my area?

Your state will send you a notice at least 60 days before Kaiser stops serving your area. You will have time to choose a different Medicaid plan. Your state Medicaid agency will show you other plans available in your county and help you enroll in one before your Kaiser coverage ends.