Medicaid is a state program

Questions about Medicaid wound care in Missouri and Illinois start with one fact: each state runs its own Medicaid program. Missouri’s program is called MO HealthNet. Illinois Medicaid is run by the Illinois Department of Healthcare and Family Services. The two have different rules, different health plans and different lists of enrolled providers.

Gateway arranges care on both sides of the Mississippi, but we are not a Medicaid office or the treating practice. We cannot tell you that a service is a covered benefit. The questions below will help you ask the people who can.

Find out which kind of Medicaid you have

Your answers depend on how your coverage is set up. Check your cards and any letters from the state.

  • A managed care health plan. Many members in both states are enrolled in a health plan that has a contract with the state. The plan has its own member card, network and rules. In Illinois, the managed care program is called HealthChoice Illinois.
  • Coverage directly through the state. Some members are not in a health plan. The state program pays enrolled providers directly.
  • Medicare and Medicaid together. Some people have both programs.
  • Limited or conditional coverage. Some categories pay only for certain services, or have a spend down amount to meet first.

Questions for MO HealthNet members

  1. Am I in a MO HealthNet managed care health plan, or is my coverage directly through the state?
  2. Is this treating practice enrolled with MO HealthNet, and is it part of my health plan’s network?
  3. Do I need a referral from my primary care clinician for wound care visits?
  4. Do visits at home, dressings or equipment need prior authorization?
  5. Will I owe a copay, or do I have a spend down that applies?
  6. How do I ask for a ride to a medical appointment, and how much notice is needed?

Questions for Illinois Medicaid members

  1. Which HealthChoice Illinois health plan am I in, if any?
  2. Is this treating practice enrolled with Illinois Medicaid and part of my plan’s network?
  3. If the practice or supplier is based in Missouri, can my plan pay it?
  4. Does my plan require a referral or prior authorization for wound care, supplies or equipment?
  5. Does my plan give me a care coordinator, and how do I reach that person?
  6. How do I schedule a ride to a medical appointment through my plan?

Living on one side of the river, care on the other

In the St. Louis region, people cross the river for health care all the time. Medicaid does not cross as easily. A provider generally has to be enrolled with your state’s Medicaid program, and with your health plan if you have one, before it can be paid for your care.

When you talk with Gateway by phone, tell us which state your Medicaid comes from and where you live. Our Metro East page describes the Illinois communities where we arrange care, and the request care form is a simple way to ask for a call back.

If you have Medicare and Medicaid

People with both programs are sometimes called dual eligible. In general, Medicare pays first and Medicaid may help with costs that remain. Some people are enrolled in a single plan designed for members who have both.

Show every card you have to the treating practice and to each supplier. Then read Medicare and wound care questions to ask, or Medicare Advantage and wound care questions if your Medicare comes through a private plan.

Supplies, equipment and rides

Dressings and equipment usually come from a supplier. Ask whether the supplier is enrolled with your state’s Medicaid program, whether an approval is needed and how refills are requested. Gateway helps with wound supply and equipment coordination, but your plan or state program decides what is paid.

Medicaid programs generally offer help with rides to medical appointments for members who qualify. Booking rules differ by state and plan. See planning transportation for wound care for what to have ready when you call.

Keep your coverage active

Medicaid has to be renewed, usually once a year. A missed renewal letter can interrupt coverage in the middle of treatment.

  • Open every letter from the state or your health plan
  • Report a new address or phone number promptly
  • Tell the treating practice and Gateway right away if your coverage changes or ends

The insurance page explains who answers which coverage question.

Common questions

Can I keep my Missouri Medicaid if I move to Illinois?

No. Medicaid does not transfer between states. If you move across the river, you apply in your new state and report the move to the old one. Tell Gateway and the treating practice before you move, and ask how the change may affect your visits, supplies and any approvals already in place.

How do I find out which Medicaid health plan I am in?

Look for a plan member card in addition to your state Medicaid card. Your plan should also have sent a member handbook when you enrolled. If you cannot find either, call the number on your state Medicaid card and ask which plan, if any, you are in and how to reach its member services line.

What if my Medicaid application is still pending?

Tell the treating practice before a visit is scheduled and ask how it handles pending coverage. Ask the Medicaid office whether an approval could apply to earlier dates. If a wound is getting worse quickly, contact a clinician, and call 911 for an emergency.

Does it matter that I live in assisted living or a nursing facility?

It can. A facility stay may be paid for in a different way than care at home, and some services may be part of what the facility already provides. Ask the facility’s business office and your Medicaid plan how visits from an outside wound clinician are handled for residents with your coverage.

Related pages

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.

Updated October 2026