CareSource is a Medicaid managed care plan, not Medicaid itself

CareSource is a private insurance company that contracts with state Medicaid programs to deliver coverage to Medicaid members. When your state's Medicaid program assigns you to CareSource, you receive your Medicaid benefits through CareSource's network of doctors, hospitals, and pharmacies instead of directly from the state.

This arrangement is called Medicaid managed care. Your state still funds your coverage and sets the rules, but CareSource handles the day-to-day work: processing claims, managing your care, and coordinating with providers. You pay the same Medicaid copays (usually $0 to $3 per visit), and your coverage includes the same services your state's Medicaid program offers.

CareSource operates in multiple states, including Ohio, Indiana, Kentucky, and others. The specific services covered and the provider network vary by state and by which Medicaid program you're in — regular Medicaid, Medicaid for seniors, or Medicaid for people with disabilities.

Key Takeaways

  • CareSource is a managed care company that delivers Medicaid benefits on behalf of your state, not a separate program you choose independently.
  • Your state's Medicaid program assigns you to CareSource or another managed care plan; you do not pick your plan in most cases.
  • You keep all the same Medicaid coverage and copays, but you must use CareSource's network of doctors and hospitals.
  • If CareSource is not in your state or your state does not use managed care, you receive Medicaid directly from the state instead.

How assignment to CareSource works

When you become Medicaid-may be able to access, your state assigns you to a managed care plan — often CareSource, but sometimes another company. The state chooses which plan based on availability in your county and the plan's capacity. You do not usually get to pick your plan, though some states allow you to switch plans once a year or if you have a may have access to reason.

Once assigned, you receive a CareSource member ID card in the mail. This card works like any other insurance card: you show it to your doctor, hospital, or pharmacy. Your state continues to pay CareSource to cover your care, and CareSource pays the providers from that funding.

If you move to a state where CareSource does not operate, or if your state does not contract with CareSource, you will be assigned to a different plan or receive Medicaid directly from the state.

What services CareSource covers

CareSource covers the same Medicaid services your state offers: doctor visits, hospital stays, emergency care, prescription drugs, mental health services, and preventive care. The exact list depends on which Medicaid category you're in and your state's rules.

CareSource also coordinates your care, meaning they may assign you a primary care doctor who oversees your treatment and refers you to specialists. Some CareSource plans include extra services like dental, vision, or transportation to medical appointments — again, this varies by state and plan.

To find out what your specific CareSource plan covers, call the number on your member card or log into your online account. Your state's Medicaid website also lists covered services.

Using CareSource's provider network

CareSource maintains a network of doctors, hospitals, specialists, and pharmacies in your area. You must use in-network providers to receive full coverage. If you see an out-of-network provider without authorization, you may owe the full bill.

When you need care, call your primary care doctor first (or CareSource's nurse line if you don't have one yet). They can refer you to a specialist or hospital within the network. For emergencies, go to the nearest emergency room — CareSource covers emergency care even at out-of-network hospitals.

You can search CareSource's provider directory on their website or call customer service to confirm a doctor is in-network before you schedule an appointment.

Differences between CareSource and direct Medicaid

If your state uses managed care, you receive Medicaid through CareSource or another plan. If your state does not use managed care, you receive Medicaid directly from the state, and there is no insurance company in the middle. Both routes provide the same coverage and copays.

The main practical difference is that with CareSource, you have a member card and a customer service number specific to CareSource, and you must use their network. With direct Medicaid, you may have more flexibility in choosing providers, depending on your state. However, many states have moved to managed care because it can reduce costs and improve coordination of care.

What to do if you have problems with CareSource

If CareSource denies a claim, refuses to cover a service, or you have trouble accessing care, you have the right to file a complaint or appeal. Start by calling the number on your member card and asking to speak with a representative about your issue.

If CareSource does not resolve it, you can file a formal appeal or complaint with your state's Medicaid agency. Your state's Medicaid website lists the steps and deadlines for appeals. You also have the right to switch plans during the annual open enrollment period if you are unhappy with CareSource.

If you believe CareSource is violating your rights or breaking state rules, you can report them to your state's insurance commissioner or Medicaid ombudsman.

Frequently Asked Questions

Do I have to use CareSource if my state assigns me to them?

Yes, if your state assigns you to CareSource, that is your Medicaid plan. You must use their network and follow their rules to receive full coverage. However, most states allow you to switch to a different plan once per year during open enrollment, or if you have a may have access to reason like moving or losing access to your doctor.

Does CareSource cost money?

No. CareSource is your Medicaid plan, and Medicaid is free or very low-cost. You may have small copays for some services (usually $0 to $3), but you do not pay a monthly premium to CareSource. Your state pays CareSource to cover you.

What if my doctor is not in CareSource's network?

You will need to find a different doctor who is in-network, or ask CareSource for an exception. Some plans allow out-of-network care if there is no in-network provider available for your condition. Call CareSource to ask about your options before switching doctors.

Can I use CareSource in a different state?

No. CareSource only works in the states where it has contracts with Medicaid. If you move to a state where CareSource does not operate, you will be assigned to your new state's Medicaid plan. Contact your new state's Medicaid office to find out which plan you are assigned to.

How do I know if CareSource is available in my state?

Check your state's Medicaid website or call your state's Medicaid office. They can tell you which managed care plans operate in your area and whether CareSource is one of them. You can also visit CareSource's website to see which states they serve.