Each Medicaid is different. In Florida if you have Medicare and Medicaid, Medicaid doesnt pay when secondary to Medicare. What they pay is the patient's Medicare premiums.
The following is from Florida Statute 409.908 (13)(b)Medicaid will pay no portion of Medicare deductibles and coinsurance when payment that Medicare has made for the service equals or exceeds what Medicaid would have paid if it had been the sole payor. It has never been the intent of the Legislature with regard to such services rendered by physicians that Medicaid be required to provide any payment for deductibles, coinsurance, or copayments for Medicare cost sharing, or any expenses incurred relating thereto, in excess of the payment amount provided for under the State Medicaid plan for such service.