Helping Connect Enrollees to Care

This page provides state Medicaid agencies with suggested outreach messages and resources that can be used to:

  • Help new enrollees establish a regular source of health care

  • Promote use of preventive health care services

States can post these materials on their own Medicaid and Children Health Insurance Program (CHIP) websites and incorporate them into handbooks, newsletters, and social media targeted to new enrollees. The messages and resources are divided into four areas of care on this page:

Using your Health Insurance

Once you're enrolled, your Medicaid or CHIP coverage can help cover medical costs for services like:

  • Going to the doctor
  • Filling a prescription at the pharmacy
  • Getting emergency care

If you haven't had health insurance before or if it's been a while, you may want to learn about using your coverage and improving your health. Check out the Roadmap to Better Care and a Healthier You. It provides tips on:

  • Understanding your coverage

  • Finding a health care provider

  • Making an appointment

  • Preparing for your first visit

  • Deciding if you like your health care provider

  • Taking your next steps to good health

Emergency Care

  • If you have an emergency or a life-threatening situation, call 9-1-1.
  • For non-urgent care, like check-ups, managing a chronic condition like diabetes or high blood pressure, or a mental health problem, you should make an appointment to see your doctor or primary care provider.
  • You may have a higher copay or coinsurance for visits to an emergency department or urgent care center than you may have for a visit to your primary care provider especially if you go to the Emergency Department for something that is not an emergency.
  • Visiting your primary care provider is usually different from visiting the emergency department or urgent care center. Here are some examples of those differences:
Primary Care Provider Emergency Department
You go when you feel sick and also when you are well but need a check-up. You go only when you’re very sick or have a life-threatening situation.
You will usually see the same provider each time. You will see the provider who is working that day.
Your provider will check all areas of your health, including areas you weren’t concerned about. The provider will check mainly the problem/illness that brought you to the emergency department or urgent care center.
Your provider will be able to access your complete health record and help you with your health over the long term. The provider who sees you may or may not be able to access your full health record or health history.

Finding a Health Care Provider (doctor or dentist)

To find a doctor: 

  • If you already have a doctor or pharmacist, ask if he or she accepts Medicaid, CHIP or the health plan you selected.  If so, you can stay with the person you know, if you want.
  • Visit your health plan’s website or call your health plan’s member services department for help. You can find the phone number on your eligibility letter or on the back of your insurance card.
  • Visit [State Medicaid or CHIP Agency website] or call [State Medicaid or CHIP Agency name and phone number] for information on finding a doctor.

To find a dentist:

  • All children enrolled in [name of state Medicaid or CHIP program] have dental coverage. For help finding a dentist for your child, use the Find a Dentist for Your Kid search tool.
  • Dental coverage for adults depends on the state where you are enrolled. Call the phone number on your health insurance card to find out if you have dental coverage and how to find a dentist near you who takes your insurance.
  • Be sure to let your doctor or dentist know that you’re enrolled in [name of state Medicaid or CHIP program], or give them the name of your health plan when you make an appointment for care.
  • If you’re having trouble getting an appointment to see a health care provider, call [State Medicaid or CHIP Agency] or your health plan’s member services department for help.

What to bring to your first visit:

  • Information on your family's health history (including parents, grandparents, etc.) This information will help you and your doctor better understand what screenings you should get and what to watch for in the future.
  • Information on medicines you take, including any prescription drugs, over-the-counter drugs, vitamins and supplements that you are taking now.
  • Medical records, including immunization records, if you have them.

Preventive Care Visits and Services

  • A preventive care visit is a scheduled appointment with your doctor when you're not sick. This is a time for you to talk to your doctor about how to stay healthy.
  • Most preventive care visits include a medical history, physical exam, health counseling, health screenings and immunizations.  At this visit, your doctor may:

    • Discuss your medical and family history, current health conditions and prescriptions
    • Check your blood pressure, weight, and height
    • Provide preventive services or refer you to a place where you can get the services you need
  • Preventive services can detect health problems early, when they are easier to treat. They include health care screenings, check-ups, and patient counseling that help to prevent illnesses or detect illness at an early stage, when treatment is likely to work best. Examples of preventive services include Pap tests, flu shots, mammograms, and reproductive health counseling.
  • Ask your health care provider what preventive services you need.
  • Medicaid pays for many preventive services.
  • Most new enrollees pay nothing for many preventive services. During a visit when your doctor provides a preventive service, if he or she also performs additional tests or services that aren't covered under the preventive benefit, you may have to pay a co-pay.
  • Visit healthfinder.gov to find out which preventive services you might need and for tips on how to stay healthy.

Some states have included information about preventive services on their marketplace websites. Below are a few examples:

Colorado (https://connectforhealthco.com/)

  • A typical health insurance policy also covers preventive care, such as vaccines and checkups, to keep you healthy.
  • In addition, health insurance helps cover the costs of wellness care that can prevent illness and promote good health.

Kentucky (https://kyenroll.ky.gov/)

  • Plans must cover preventive care at no extra cost to you, including flu and pneumonia shots and routine vaccinations.
  • Plans must also cover most cancer screenings, such as mammograms and colonoscopies.

Maryland (https://www.marylandhealthconnection.gov/)

  • Health coverage helps pay the rising costs of medical care when you or a family member is sick or injured. But coverage plans offered in the marketplace also pay for services that may help you and your children prevent health problems. There are many benefits of health insurance. Some examples of covered services include screenings for high cholesterol, diabetes and depression; immunizations and vaccines for children and adults, mammograms and more.
  • All plans must also cover preventive and wellness care, as well as chronic disease management, at no extra cost to you, including:

    • Flu and pneumonia shots
    • Birth control
    • Routine vaccinations
    • Screenings for cancer, such as mammograms and colonoscopies

To share what your state is doing to reach out to new enrollees, or for additional technical assistance, please contact MedicaidCHIPPrevention@cms.hhs.gov.