Covered Services

CareSource covers all medically necessary Medicaid-covered services. These medical services are available at no charge to you. You should not be billed for these services. If you receive a bill, please call us.

You can get many services without a referral from your Primary Care Provider (PCP). This means that your PCP does not need to arrange or approve these services for you. Just check your Provider Directory for a list of participating providers who offer these services and schedule an appointment yourself.

 

Other services require a referral. This means that your PCP will recommend or request these services for you before you can get them. Your PCP will either call or arrange these services for you, give you written approval to take with you when you get the referred services, or just tell you what to do.  In some cases, CareSource may authorize a specialist to make referrals for you.

A few services require both a referral from your PCP and Prior Authorization from CareSource before you get them. Your PCP will ask for a Prior Authorization from us and then schedule these services for you. If you are seeing a specialist, he/she will get approval from your PCP, then your appointment or services will be scheduled.

You can learn about covered medications by clicking on Pharmacy. Or learn more about our Transportation benefit.

Please click on the links to the left to learn more. You can also learn more by reading your Member Handbook.

Services not covered

CareSource will not pay for the following services that are not covered by Medicaid:

  • All services or supplies that are not medically necessary
  • Experimental services and procedures, including drugs and equipment, not covered by Medicaid
  • Organ transplants that are not covered by Medicaid
  • Abortions except in the case of a reported rape, incest or when medically necessary to save the life of the mother
  • Infertility services for males or females, including reversal of voluntary sterilizations
  • Voluntary sterilization if legally incapable of consenting to the procedure Cosmetic surgery that is not medically necessary
  • Inpatient treatment to stop using drugs and/or alcohol (In-patient detoxification services in a general hospital are covered)
  • Services for the treatment of obesity unless determined medically necessary
  • Inpatient hospital custodial care
  • Acupuncture and biofeedback services
  • Services to find cause of death (autopsy)
  • Comfort items in the hospital (e.g. TV or phone)
  • Paternity testing

This is not a complete list of the services that are not covered by Medicaid or CareSource. If you have a question about whether a service is covered, please call Member Services at 1-800-993-0780 (TTY 1-800-750-0750 or 711).