Anthem is a private insurance company that administers Medicaid plans in many states

Anthem is not Medicaid itself — it is a for-profit health insurance company that manages Medicaid coverage on behalf of state governments. When your state contracts with Anthem, Anthem becomes the middleman between you and the state's Medicaid program. You receive a card from Anthem, you call Anthem's customer service, and you use Anthem's provider network — but the coverage and the money still come from your state's Medicaid budget.

Anthem operates Medicaid plans in roughly 20 states, though the exact number changes as states add or drop contracts. The plan names vary by state: some are called Anthem Medicaid, others are branded as regional plans like Anthem Blue Cross Blue Shield Medicaid. The coverage you receive is still Medicaid — the same program you would have under a different insurer — but the experience of using it is shaped by Anthem's network and policies.

Key Takeaways

  • Anthem is a private company hired by your state to manage Medicaid, not a separate program or a different type of coverage.
  • You receive an Anthem card and use Anthem's provider network, but your coverage is still state Medicaid with the same income limits and covered services.
  • If you live in a state where Anthem manages Medicaid, you cannot choose a different Medicaid insurer — Anthem is your only option in that region.
  • Anthem's customer service phone number and website are on your card; they handle claims, prior authorizations, and provider questions.

How Anthem Medicaid differs from traditional Medicaid

In some states, Medicaid is run directly by the state health department, and you deal with the state for everything. In states where Anthem manages Medicaid, the state still sets the rules and pays the bills, but Anthem handles the day-to-day work: processing claims, paying doctors, managing the provider network, and handling customer service calls.

From your perspective, the main difference is who you contact. With traditional Medicaid, you call your state's Medicaid office. With Anthem Medicaid, you call Anthem. The covered services, income limits, and copayments are set by your state, not by Anthem, so the coverage itself is the same. Anthem cannot deny you coverage for something your state's Medicaid program covers, and Anthem cannot charge you more than your state allows.

Which states use Anthem to manage Medicaid

Anthem manages Medicaid in Connecticut, Delaware, Georgia, Indiana, Kentucky, Louisiana, Maine, Missouri, Nevada, New Hampshire, New Mexico, New York, Ohio, Pennsylvania, Rhode Island, Texas, Virginia, and West Virginia. The list changes periodically as states end contracts or add new ones. Your state's Medicaid office website will tell you which companies manage Medicaid in your region.

Even within a state that contracts with Anthem, you may have a choice of Medicaid insurers in your area. Some states use multiple companies, and you pick one during enrollment. Other states assign you to Anthem automatically. Your state's Medicaid website or your local Medicaid office can tell you whether you have a choice and how to make it.

What to do if you are assigned to Anthem Medicaid

When you are approved for Medicaid in a state where Anthem manages the program, you will receive an Anthem Medicaid card in the mail within one to two weeks. The card shows your member ID, group number, and Anthem's customer service phone number. Keep this card with you when you see a doctor.

Before your first appointment, call the number on your card or visit Anthem's website to find doctors and hospitals in your network. Using an in-network provider means lower or no copayments. If you need a specialist, you may need a referral from your primary care doctor — ask when you schedule. If you need a service that is not routine, such as surgery or mental health treatment, Anthem may require prior authorization, meaning the doctor must get Anthem's approval before the service happens.

How to contact Anthem Medicaid and get help

The phone number for Anthem Medicaid customer service is on your card. You can also visit Anthem's website for your state — search "Anthem Medicaid [your state name]" to find it. On the website, you can view your coverage details, find providers, check claim status, and request a replacement card.

If you have a problem — a claim was denied, a doctor is not in the network, or you cannot reach someone — start by calling the number on your card. If you do not get the answer you need, contact your state's Medicaid office directly. Your state's Medicaid office oversees Anthem and can investigate complaints or override Anthem's decisions if the state believes Anthem made an error.

Anthem Medicaid versus Medicaid Advantage or other managed care plans

Anthem Medicaid is different from Medicare Advantage, which is a private plan for people over 65 or with certain disabilities. Anthem Medicaid is also different from Medicaid Advantage or Medicaid managed care plans in some states — though the names are confusing, they are the same thing. Medicaid managed care means a private company (like Anthem) manages your Medicaid coverage, which is what Anthem does.

The key point: if you are under 65, not yet on Medicare, and you have Medicaid, and your state uses Anthem, then you have Anthem Medicaid. It is Medicaid, not a separate program. You pay the same copayments, see the same covered services, and have the same income limits as anyone else on your state's Medicaid program.

What happens if you move to a different state

If you move to a state where Anthem does not manage Medicaid, your Anthem card will no longer work. You will need to apply for Medicaid in your new state. That state may use a different insurance company, or it may run Medicaid directly. You will receive a new card and new customer service information.

Before you move, contact your current Anthem plan to find out what to do with your card and any ongoing prescriptions or treatments. Your new state's Medicaid office can tell you how to apply and which insurance company (if any) will manage your coverage there.

Frequently Asked Questions

Is Anthem Medicaid the same as regular Medicaid?

Yes. Anthem is the company that manages the Medicaid program in your state, but the coverage, income limits, and services are all set by your state. You have Medicaid; Anthem is just the company you interact with to use it.

Can I choose a different Medicaid insurance company instead of Anthem?

That depends on your state. Some states let you pick from multiple Medicaid insurers during enrollment; others assign you to Anthem automatically. Check your state's Medicaid website or call your state's Medicaid office to find out whether you have a choice in your area.

Do I have to pay Anthem directly for my Medicaid coverage?

No. Medicaid is paid for by your state and the federal government. You do not pay Anthem a premium. You may have small copayments when you see a doctor or fill a prescription, but those go to the provider, not to Anthem.

What if Anthem denies a claim or refuses to cover something?

Ask Anthem in writing why the claim was denied. If you disagree, you have the right to appeal. Your state's Medicaid office oversees Anthem and can investigate if you believe Anthem made a mistake or violated state rules. Contact your state's Medicaid office for help with an appeal.

How do I find a doctor who takes Anthem Medicaid?

Call the number on your Anthem card or visit Anthem's website for your state. Both have a provider search tool where you can enter your location and the type of doctor you need. Doctors in the network have agreed to accept Anthem Medicaid and will have lower copayments than out-of-network providers.