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Your Primary Care Physician (PCP)

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. You will need your PCP’s okay, called a referral, in order for Medicaid or ARKids First to pay.

Do you need a PCP?

You must pick a PCP unless:

  • you also have Medicare.
  • you live in a nursing home.
  • you live in an ICF/IID (a home for people with intellectual disabilities).
  • 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.)

How do you get a PCP?

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 or ARKids First, 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.

How do you change your PCP?

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.

Choosing a PCP

For each family member on Medicaid or ARKids First, pick 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.