Key result
Most US states cover outpatient cardiac rehabilitation under Medicaid, but coverage gaps persist across several states.
Why the study?
Access to outpatient cardiac rehabilitation for Medicaid beneficiaries is inconsistent due to variable state coverage policies, potentially limiting equitable care.
Cross-Sectional
Yes
Geographic variation in state Medicaid reimbursement policies for cardiac rehabilitation limits access to evidence-based cardiovascular care for vulnerable populations.
State Medicaid CR reimbursement policies vary widely; leaves open whether standardization would reduce access inequities for beneficiaries.
BACKGROUND: Cardiac rehabilitation (CR) is a guideline-supported, evidence-based intervention that improves cardiovascular outcomes, yet access remains inconsistent for Medicaid beneficiaries because coverage policies vary across states. PROJECT RATIONALE: We evaluated Medicaid reimbursement for outpatient CR services across all 50 U.S. states to identify policy variation that may contribute to inequitable access for vulnerable populations. PROJECT SUMMARY: A cross-sectional survey review of state Medicaid fee schedules, provider manuals, coverage policies, and direct communication with Medicaid agencies assessed reimbursement for Current Procedural Terminology codes 93797 and 93798. Most states provided coverage, but important geographic variation remained, with several states lacking reimbursement for one or both services. Limited coverage frequently occurred in regions with large Medicaid populations, potentially restricting access to guideline-supported cardiovascular care. TAKE-HOME MESSAGES: State Medicaid reimbursement policies remain an important determinant of access to outpatient CR. Greater policy consistency may reduce disparities and improve equitable delivery of evidence-based cardiovascular care.
No takes yet. Share an insight, caveat, or question.
Henson et al. (2026) conducted a cross-sectional in Medicaid beneficiaries requiring cardiac rehabilitation. State Medicaid reimbursement policies for outpatient cardiac rehabilitation was evaluated on Medicaid reimbursement for Current Procedural Terminology codes 93797 and 93798. While most U.S. states provided Medicaid coverage for outpatient cardiac rehabilitation, several states lacked reimbursement for one or both services.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: