A primary care physician, also called a PCP, is a doctor who takes care of you and helps you stay healthy. Your PCP will provide most of your health care. Your PCP will keep a record of your health and your health care. If you need special care for a health problem, your PCP will make the arrangements and tell you where to go. You will need your PCP’s okay, called a referral, in order for Medicaid to pay.
You must pick a PCP unless:
- you also have Medicare.
- you live in a nursing home.
- you live in an ICF/ID (a home for people who are mentally disabled).
- you are covered by Medicaid only for a past time period.
- you have Medicaid “Spend-Down.” (This means that you make too much to qualify for regular Medicaid, but you spend the excess amount on medical bills.)
The ways to choose a PCP are:
- Go to the doctor’s office,
- Call the ConnectCare help line at 1-800-275-1131 (TDD: 1-800-285-1131),
- Go to the DHS office in your county, or
- List your choices for a PCP on the Medicaid application.
You must make sure the PCP you choose is a Medicaid provider. If you need a list of PCPs who take Medicaid, call ConnectCare or visit your county DHS office. The list tells you:
- The doctor’s name.
- The clinic’s address.
- Ages served.
- Languages the doctor or staff speak.
- Phone numbers.
To change your PCP, call the ConnectCare help line at 1-800-275-1131 (TDD: 1-800-285-1131), or visit the DHS office in your county.
For each family member on Medicaid, pick three doctors. If a doctor you choose cannot take more patients, DHS will try to give you your next choice. Choose carefully. Here are some things to keep in mind:
- How far away is the doctor? The doctor’s clinic needs to be in the county where you live or in a county right beside yours. If you live in a county that borders another state (Oklahoma, Texas, Louisiana, Mississippi, Missouri, or Tennessee), you may choose a doctor in a city on the border in that state. Make sure the doctor takes Arkansas Medicaid.
- Do you or your family members have special needs? Look for a doctor that offers the service you need.
- Is there a hospital you like best? Make sure the doctor you choose sends patients to that hospital. (Remember for emergency care you can use any hospital. Other times, you need a doctor’s referral.)
- Does a family member not speak English? Choose a doctor who speaks their language.