Charging for forms when your patient has Medicaid, state by state

The short answer

The federal FMLA rules put the cost of the certification on the employee, and no federal rule says you have to complete the form for free. Medicaid is where that changes. In most states, what Medicaid pays for a covered visit is payment in full, and you cannot bill the patient for anything Medicaid treats as part of that visit. The hard part is that very few states say whether completing a leave form is part of the visit or a separate service Medicaid does not cover.

So what I would do is assume you cannot charge a patient who has Medicaid, and then look at your state below. A handful of states say no in plain words, a handful allow a charge with conditions, and most say nothing I could find. This is one physician’s reading of each state’s own rules, not legal advice, and a Medicaid managed care plan’s contract can be stricter than the state’s manual.

The rule: 29 C.F.R. §§ 825.305 and 825.308 (the employee pays for the certification); each state’s Medicaid regulation or provider manual, linked below.

States where Medicaid says you cannot charge

These states have a Medicaid rule that reaches form completion. Only Maryland names forms outright. The others say the form is part of what they already paid for, so in practice the answer is the same, but none of them names the FMLA form, so applying their rule to a WH-380-E is my reading.

• Maryland. The Medicaid regulation lists “Completion of forms and reports” among the things a provider may not bill the Department or the participant for. My understanding is that this is the plainest rule in the country, and it covers both the patient and Medicaid. COMAR 10.09.02.07.
• Tennessee. TennCare says the payment for the visit “includes filling out forms,” and its example makes clear this holds even when the form arrives after the visit. TennCare policy PRO 08-001.
• Texas. The Medicaid provider manual says it is not acceptable to charge Texas Medicaid clients or their family for signing forms. The passage sits in a discussion of forms tied to covered care, so whether it reaches a stand-alone FMLA form is not settled, but I would not charge. Texas Medicaid Provider Procedures Manual, § 1.7.11.
• New York. The physician manual says completing a form “does not justify a separate bill to Medicaid,” and that billing the enrollee for a covered cost is an unacceptable practice. NY Medicaid Physician Policy Guidelines.
• Delaware. You may not charge a Medicaid member separately for paperwork that supports their covered care. The manual does allow a charge for paperwork that is not related to their care, if your office charges every patient for it and you tell the member beforehand. Whether an FMLA form is related to their care is a judgement call, and I would treat it as related. DMAP General Policy Manual, § 1.17.
• California. State law makes forms that support a Medi-Cal eligibility claim free. At least one large Medi-Cal plan, Health Net, also bars a fee for any form related to services Medi-Cal covers, with school and sports physicals, employment exams and insurance forms among its examples. Health Net Medi-Cal provider manual.

Arkansas and Mississippi forbid charging a Medicaid patient for the Medicaid claim form itself, but I found nothing in either state that addresses a leave form.

States that allow a charge, with conditions

In these five states, Medicaid lets you bill the patient for a service Medicaid does not cover, and each attaches conditions. The common thread is that the patient has to be told beforehand, in writing, that Medicaid will not pay and they will.

• Oregon. Medicaid does not pay for preparing documents, and you may charge the patient for a non-covered service only if they knowingly and voluntarily agree to pay, using Oregon’s own advance agreement process. OAR 410-120-1280.
• Pennsylvania. You may bill a Medical Assistance patient for a service the program does not cover if you tell them beforehand. One large plan, Keystone First, says the payment for a required exam or visit includes completing the forms, allows a reasonable fee for a stand-alone form with written notice, and says to waive it if the patient says they cannot afford it. 55 Pa. Code § 1101.63.
• South Dakota. A non-covered service can be billed to the patient if you tell them beforehand that Medicaid will not pay. The state has its own notice form, the MS101, for that. SD Medicaid, Billing a Recipient.
• Oklahoma. SoonerCare lists “completion of insurance forms, abstracts, narrative reports” among the things it does not pay for, and says a member can be billed only for a non-covered service. The rule does not name leave forms. OAC 317:30-5-2.
• Missouri. The MO HealthNet manual says non-covered services may be billed to the participant, and lists preparing special reports sent to insurance companies. Whether a form for an employer counts the same way is not addressed. MO HealthNet Physicians Provider Manual, § 2.35.

Everywhere else, nothing I could find

In the other states and the District of Columbia, I found no Medicaid rule that says whether completing a leave form is covered or can be charged. That is not the same as permission. Every state forbids billing a Medicaid patient for a covered service, so if your state would see the form as part of the visit, charging for it is a problem even though no rule names it.

Arizona is a good example, because the question comes up. AHCCCS says providers may not bill members for covered services, and I could not find anything in its manuals that says whether a leave form is covered. Indiana is similar. It forbids charging Medicaid members for copies of records, and says nothing I could find about completing a new form. In a state like this, what I would do is call your Medicaid plan’s provider line and ask, and write down who told you what.

A separate question: your state’s own leave forms

Some states run their own paid leave or disability program, and a few of them set the fee rule for their own certification, whatever insurance the patient has.

Two more states set a rule for the federal form itself. Nevada caps the fee for an FMLA certification at $30, adjusted each year, so I would check the state’s current figure before posting a fee (NRS 629.0625). North Carolina’s Medical Board says a reasonable fee is fine for a complex form, simple forms should be done without a fee, and patients should get your written forms policy when they join the practice.

What I would do at the front desk

I would ask whether the patient has Medicaid when the form is dropped off, not after it is done, because that is the point where the answer changes. If they do, in most states I would complete the form without a charge, ideally at a visit, and treat it as part of their care. If you are in one of the five states that allow a charge, I would use that state’s own notice process, get the patient’s signature before doing the work, and waive the fee for hardship. For everyone else, the fee policy on the charging page applies.

Questions the office asks

Can I charge a Medicaid patient for FMLA paperwork?

In most states I would assume not. Maryland, Tennessee, Texas, New York, Delaware and California have Medicaid rules that, in my reading, rule it out, and only Oregon, Pennsylvania, South Dakota, Oklahoma and Missouri allow a charge, each with conditions such as telling the patient in writing beforehand.

Can an AHCCCS patient be billed for FMLA paperwork?

AHCCCS forbids billing members for covered services, and I could not find anything in its manuals that says whether a leave form is covered. I would not charge, and I would ask your plan’s provider line if you want a firm answer.

Can I charge for my state’s paid leave forms?

In Connecticut, Delaware, New Jersey and Washington, no. Delaware’s public plan pays you $20 instead if you submit within 10 days. California’s EDD and DC’s paid leave rule both say a fee is allowed.

Is there a cap on what I can charge for FMLA paperwork?

Nevada is the only state where I found one. Its law caps the fee at $30, adjusted each year. Elsewhere, practices that publish their fees mostly charge $25 to $65 per form.