Your Primary Care Physician (PCP)
A primary care physician, also called a PCP, is a doctor who takes care of you and helps you stay healthy. Your
PCP
will provide most of your health care. Your
PCP
will keep a record of your health and your health care. If you need special care for a health problem, your
PCP
will make the arrangements and tell you where to go for medical services. You will need your
PCP’s
okay, called a referral, in order for Medicaid to pay for this special medical care.
Do you need a
PCP?
How do you get a
PCP?
How do you change your
PCP?
Choosing a
PCP
You must choose a
PCP
unless:
- you also have Medicare.
- you live in a nursing home.
- you live in an
ICF/IID
(a home for people who have an intellectual disability).
- you are covered by Medicaid only for a past time period.
- you have Medicaid “Spend-Down.” (This means that you make too much to qualify for regular Medicaid, but you spend the excess amount on medical bills.)
The ways to choose a
PCP
are:
- Go to the doctor’s office,
- Call the ConnectCare help line at 1-800-275-1131 (TDD: 1-800-285-1131),
- Go to the
DHS
office in your county,
or
- List your choices for a
PCP
on the Medicaid or ARKids First application.
You must make sure the
PCP
you choose is a Medicaid or ARKids First provider. If you need a list of
PCPs
who take Medicaid, call ConnectCare or visit your county
DHS
office. The list tells you:
- The doctor’s name.
- The clinic’s address.
- Ages served.
- Languages the doctor or staff speak.
- Phone numbers.
To change your
PCP, call the ConnectCare help line at 1-800-275-1131 (TDD: 1-800-285-1131), or visit the
DHS
office in your county.
For each family member on Medicaid or ARKids First, choose three doctors. If a doctor you choose cannot take more patients,
DHS
will try to give you your next choice. Choose carefully. Here are some things to keep in mind:
-
How far away is the doctor?
The doctor’s clinic needs to be in the county where you live or in a county right beside yours. If you live in a county that borders another state (Oklahoma, Texas, Louisiana, Mississippi, Missouri, or Tennessee), you may choose a doctor in a city on the border in that state. Make sure the doctor takes Arkansas Medicaid and ARKids First.
- Do you or your family members have special needs? Look for a doctor that offers the service you need.
- Is there a hospital you like best? Make sure the doctor you choose sends patients to that hospital. (Remember for emergency care you can use any hospital. Other times, you need a doctor’s referral.)
- Does a family member not speak English? Choose a doctor who speaks their language.