Molina Healthcare is a private company that runs Medicaid plans, not Medicare plans

Molina Healthcare is an insurance company contracted by state Medicaid programs to deliver coverage to people who may have access to for Medicaid. Molina itself is not Medicaid — it is a private insurer that manages Medicaid benefits on behalf of the state. This matters because it changes who you contact when you have a problem, where your coverage comes from, and what your rights are.

Molina operates Medicaid managed care plans in multiple states, meaning the state pays Molina to provide healthcare to Medicaid members instead of the state running the program directly. You cannot sign up with Molina directly; you must first be found may be able to access for Medicaid by your state, and then your state may assign you to a Molina plan or you may choose it from a list of available plans.

Molina does not offer Medicare plans. If you are over 65 or have certain disabilities and receive Medicare, you would work with a different insurance company if you chose a Medicare Advantage plan. Some people have both Medicaid and Medicare (called "dual may be able to access"), but those are two separate programs, and Molina would handle only the Medicaid portion.

Key Takeaways

  • Molina Healthcare is a private insurance company that manages Medicaid benefits for your state, not a government program itself.
  • You must be found may be able to access for Medicaid by your state first; Molina does not determine Medicaid may be able to access.
  • Molina operates in some states but not others, so whether you can use Molina depends on where you live and which plans your state offers.
  • If you have Medicare, Molina does not provide your Medicare coverage, though you may have Molina for Medicaid if you are dual may be able to access.
  • When you have a problem with Molina coverage, you file a complaint with your state's Medicaid agency, not with Molina alone.

How Molina fits into the Medicaid system

States run Medicaid, but most states contract with private insurance companies to manage the day-to-day work of paying doctors, processing claims, and handling member services. Molina is one of several companies that do this work. When you are found may be able to access for Medicaid, your state assigns you to a managed care plan — which might be Molina, or might be another company like Centene, UnitedHealth, or Anthem, depending on your state and the plans available in your area.

Molina collects a monthly payment from your state for each person enrolled in its plan. In return, Molina pays your doctors and hospitals, manages your prescriptions, and handles your customer service calls. But the money comes from Medicaid — the federal and state program — not from Molina's own pocket. Molina is the middleman between you and the state's Medicaid funding.

This structure exists because states believe private companies can manage costs and coordinate care more efficiently than state agencies can. Whether that is true varies by state and by plan. What matters for you is that your coverage is still Medicaid coverage, backed by Medicaid rules and Medicaid protections, even though Molina is the company you interact with most often.

Which states have Molina Medicaid plans

Molina operates Medicaid managed care plans in Alabama, Arizona, Florida, Georgia, Illinois, Louisiana, Michigan, Mississippi, Missouri, New Mexico, Ohio, South Carolina, Texas, Utah, Washington, and Wisconsin. This list changes as Molina wins or loses state contracts, so the states where Molina operates today may not be the same next year.

Even in states where Molina operates, you may not have Molina as an option. Your state may offer multiple managed care plans, and you might be assigned to a different company, or you might be able to choose from a list that includes Molina but also includes others. Some people in Medicaid are not in managed care at all — they receive Medicaid directly from the state — though this is less common than it used to be.

To find out whether Molina operates in your state and whether you can use it, contact your state Medicaid agency. You can find your state agency through the Centers for Medicare & Medicaid Services website, or call 211 and ask for your state Medicaid office.

The difference between Molina Medicaid and Molina Medicare Advantage

Molina does offer Medicare Advantage plans in some states, which can add to the confusion. Medicare Advantage is a different program from Medicaid. It is for people 65 and older or people with certain disabilities who have Medicare. If you have a Molina Medicare Advantage plan, that is your Medicare coverage, not your Medicaid coverage.

Some people have both Medicaid and Medicare — this is called being "dual may be able to access." If you are dual may be able to access and enrolled in a Molina Medicaid plan and a Molina Medicare Advantage plan, Molina handles both, but they are separate programs with separate rules, separate networks, and separate out-of-pocket costs. Your Medicaid plan covers some services and your Medicare plan covers others, and they coordinate with each other.

If you are not sure whether you have Medicaid, Medicare, or both, look at your insurance card. It will say "Medicaid" or "Medicare" on it. If you have both, you will have two cards. You can also call the number on your card and ask.

What to do if you have a problem with your Molina coverage

If Molina denies a claim, refuses to pay for a service, or does not respond to your request, you have the right to file a complaint. Start by calling Molina's customer service number on your insurance card and asking them to explain the decision. If you disagree, ask Molina for a written explanation of why they made that decision.

If Molina does not fix the problem, you can file a formal complaint with your state Medicaid agency. Your state has the power to investigate Molina and require them to reverse a decision or pay a claim. You can also file a complaint with your state's insurance commissioner. Both agencies have complaint processes that are free to use.

You also have the right to appeal Molina's decision through Molina's internal appeal process. Molina must tell you how to file an appeal when they deny a claim. The appeal process is different from a complaint — an appeal asks Molina to reconsider their decision, while a complaint asks the state to investigate Molina's conduct.

How to know if you are enrolled in Molina

If you have Medicaid and you are not sure which company manages your plan, look at your Medicaid card. The name of the managed care plan should be printed on it. If it says "Molina Healthcare" or just "Molina," then Molina manages your Medicaid coverage.

You can also call your state Medicaid office and ask which plan you are enrolled in. They can tell you immediately. If you want to switch to a different plan, ask your state Medicaid office when the open enrollment period is — this is usually once a year, though some states allow changes at other times if you have a good reason.

Frequently Asked Questions

Is Molina the same as Medicaid?

No. Molina is a private insurance company that manages Medicaid benefits for your state. Medicaid is the government program that pays for it. Molina is the company you contact about claims and coverage, but Medicaid is the program that funds your coverage and sets the rules.

Can I sign up directly with Molina?

No. You must first be found may be able to access for Medicaid by your state. Once you are may be able to access, your state may assign you to Molina or offer it as a choice. You cannot enroll in Molina without going through your state's Medicaid process first.

Does Molina offer Medicare?

Molina offers Medicare Advantage plans in some states, but these are separate from Medicaid. Medicare Advantage is for people 65 and older or people with certain disabilities. If you have Medicaid, that is a different program. You can have both, but they are managed separately.

What happens if Molina denies my claim?

You can ask Molina to explain the denial in writing. If you disagree, you can file an appeal with Molina or file a complaint with your state Medicaid agency. Your state can investigate and require Molina to reverse the decision if it was wrong.

Can I switch away from Molina?

Yes, usually during your state's open enrollment period, which is typically once a year. Contact your state Medicaid office to find out when you can change plans and what other options are available in your area.