Does Medicaid cover urgent care and ER visits?
Last verified:
Yes, everywhere, including emergencies in another state; a small copay may apply for non-emergency use of an ER. Federal rule: mandatory (hospital and physician services).
What federal law says
Emergency room and urgent care visits are covered under the mandatory inpatient and outpatient hospital and physician benefits in every state. Separately, the Emergency Medical Treatment and Labor Act requires any hospital with an emergency department to screen and stabilize anyone who comes in, regardless of coverage or ability to pay.
Out-of-state care is covered too, in the situations listed in 42 CFR 431.52: a medical emergency, care that the enrollee's health would suffer without, care the state's own providers cannot supply, and residents who live near a border and normally use out-of-state providers. Elective care in another state needs prior approval.
States may charge a copay for a non-emergency visit to an emergency room, and the 2025 law adds cost sharing of up to $35 per service for expansion adults above 100% of poverty from October 1, 2028; emergency services are meant to be excluded from that, though CMS guidance on the details had not been issued at our last check.
Children under 21
Covered, with no copays for children.
What to ask your state plan
- Carry the plan card; out-of-state hospitals will treat you either way but bill correctly only if they know the payer.
- Urgent care centers must be enrolled with your plan; call the plan's nurse line first if you are unsure which one is.
- Find your state's agency, program name and phone on Medicaid by state.
Related questions
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Common questions
Does Medicaid cover urgent care and ER visits?
Yes, everywhere, including emergencies in another state; a small copay may apply for non-emergency use of an ER.
Does Medicaid cover urgent care and emergency room visits for children?
Covered, with no copays for children.
How do I find out whether my state's Medicaid covers urgent care and emergency room visits?
Three places. Your plan's member handbook or benefit summary, which lists the covered services and limits; the state Medicaid agency's provider manual for the service, which is public and states the medical-necessity criteria; and the member services line on your card, which can run a coverage check for a specific procedure code. Our state pages list each agency's phone and portal.
Sources
- 42 CFR 431.52 (payment for services furnished out of state)
- CMS: Emergency Medical Treatment and Labor Act
- medicaid.gov: mandatory and optional Medicaid benefits
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