5002-5        MEDICAL SERVICES RECEIVED OUT OF STATE

Medical services may be received out of state if those services are not available in Alaska as long as the service is prior authorized and the health care provider is enrolled in the Alaska Medicaid program. Services received without prior authorization because of an emergency or because the recipient’s health would be endangered if required to return to Alaska to receive medical care may also be covered if the provider subsequently enrolls in the Medicaid program.

A recipient living in a community with convenient road access to a Canadian medical provider and no access to U.S. medical provider other than by chartered airplane may receive medical care in the Canadian community.

Medicaid will reimburse covered services provided by Canadian providers if one of the following conditions is met:

1. The services were provided because of a medical emergency. A medical emergency exists when a recipient has a severe, life threatening, or potentially disabling condition that requires intervention within minutes or hours; or
    

2. The State of Alaska has agreed that the needed health care services are more readily available in Canada at equal or less cost.

All other services received out-of-state must be prior authorized by First Health Services to be covered by Medicaid.