Pharmacist provider status in Medicaid: A state health director’s perspective on policy and practice

Abstract

Despite expanded clinical authority, pharmacists often face barriers to full provider status in Medicaid owing to outdated reimbursement policies and administrative restrictions. This paper describes Idaho’s comprehensive approach to pharmacist integration into its Medicaid program through a profession-neutral “what, not who” reimbursement framework coupled with its “standard of care” regulatory framework. Rather than defining eligibility by provider type, Idaho allows any licensed health professional to bill for Medicaid-covered services within their legal scope of practice. Key reforms included statutory changes, regulatory updates, provider enrollment optimization, and alignment of pharmacist reimbursement with midlevel providers. Pharmacists can now enroll as rendering providers and bill directly for services using their National Provider Identifier. Idaho’s model demonstrates that full pharmacist integration into Medicaid can be achieved in a framework that is scalable, bipartisan, and adaptable, offering a policy roadmap for other states seeking to enhance access to health care especially in rural settings.