Which Medicaid category requires patients to see a specific physician or use a specific pharmacy?

Medicaid's restricted status is designed to manage and control healthcare costs by requiring patients to receive services from specific providers, such as designated physicians or pharmacies. This approach is typically implemented for individuals who may have a history of over-utilization of services or non-compliance with treatment plans. By having a designated provider, the state can monitor the patient's care more closely, ensuring that they receive appropriate and necessary services while limiting inappropriate use of Medicaid resources.

This category serves important purposes including ensuring that patients receive care that is both appropriate and effective, while simultaneously helping to manage expenses within the Medicaid program. Ultimately, restricted status supports efforts to deliver quality care while safeguarding the integrity of the Medicaid system.