Get Medicaid Referral Form 2020-2024

The cascading referral permits subsequent providers to refer the recipient to additional providers without a having to request a new referral.

Recipients who are proven to have abused or misused the Medicaid program may be "locked in" to one doctor and one drug store, be required to repay the Agency for misspent funds and/or may be suspended from the program for at least one year and until full restitution is made.

If a medical emergency is referenced, the provider must submit the PA request within 30 days of the date of service. Supporting documentation must provide evidence that the service was not scheduled and that delays greater than 72 hours would have resulted in serious injury or harm.

What do I need to do? Most specialists require a referral from your primary care provider.

QI-1 or Qualified Individual (effective February 2023): Income cannot exceed $1,661 per month for an individual. Income cannot exceed $2,239 per month for a couple. Plan First/Pregnant Women/Children (Ages 0-18):* Income after deductions cannot exceed $1,774 per month for a family of 1.

Recipients who are proven to have abused or misused the Medicaid program may be "locked in" to one doctor and one drug store, be required to repay the Agency for misspent funds and/or may be suspended from the program for at least one year and until full restitution is made.

What do I need to do? Most specialists require a referral from your primary care provider. Contact your primary care provider to obtain a referral to a specialist.