Although bunions are a fairly common foot ailment, they can greatly impact mobility and lead to pain. Bunions form as the result of bone misalignment in the big toe, and over time, the big toe begins to point slightly inward while the joint bulges outward. This can make it uncomfortable to walk, run or do much of anything while standing. When left uncorrected, bunions can become inflamed, tender and sore.
Bunions occur in more women than men, and people who wear shoes that are too tight can be more prone to the development of bunions. While there are a number of things that can be done to ease the symptoms of bunions including changing footwear, surgery is generally the most successful option for a full correction. Bunion surgery helps to re-direct the bones and connective tissue to alleviate pain and pressure and bring the foot back to its natural shape.
Does Medicaid Cover Bunion Surgery?
Medicaid recipients can usually receive bunion surgery as a covered expense under Medicaid, but it’s important to note that each state has its own provisions as to what services and procedures are covered and to what degree. Additionally, different states can include stipulations that require non-invasive treatment options to be attempted first before surgery will be considered. For this reason, Medicaid services recipients who are interested in having surgery to correct bunions will need to speak with their plan managers to discuss coverage specifics.
Medicaid and Medical Necessity
Like many other surgical procedures, bunion surgery under Medicaid also requires that the operation is medically necessary in order for it to be covered. Defining medical necessity is often as simple as having a physician order a procedure, but this doesn’t mean that physicians are free to order surgery for anyone and everyone who wants it.
Doctors who are Medicaid-certified healthcare providers must adhere to the program’s guidelines. This means that they are accountable for each and every procedure, prescription and treatment they order for Medicaid patients. If a physician is found to be misappropriating resources by ordering surgery that isn’t medically necessary, meaning the procedure isn’t required to improve overall health or to treat or prevent a disease, then that doctor could face penalties.
This also means that bunion surgery will not be covered by Medicaid if it is for cosmetic purposes only. Per Medicaid regulations, cosmetic procedures, including things like plastic surgery, are not medically necessary and will not be covered. This is why, once again, you need to discuss the specifics of your case with your plan manager to determine eligibility.
Does Medicaid Cover Aftercare?
While most bunion surgeries can be completed on an outpatient basis, meaning that no overnight hospital stay is required, surgery patients will usually require a lengthy recovery time at home. This time period could last for weeks or months depending on the patient’s health and any complications they may face. During this time, there can be pain, swelling and limited mobility. Medicaid will usually cover all aftercare visits for follow-up diagnostics, and if you’re prescribed any medications after your surgery, these will likely be covered by Medicaid as well.
As a result of the potential for a difficult recovery period, it’s a good idea to plan ahead. Make sure that you have someone available who can help you get around the house and to and from your follow-up medical visits. You should also plan ahead with your employer to discuss things like short-term disability or Family Medical Leave Act excused absences. With the right resources and plan in place, your transition back to mobility will typically be faster, less painful and less costly overall.