Medicaid Services

What Services Does Medicaid Cover?

State Medicaid programs provide a range of mandatory services, but can also provide an array of “optional” services. Children are entitled to all medically necessary Medicaid benefits, whether mandatory or optional under federal law also known as Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services. States are not able to vary benefits by geographic area or by eligibility category without a Federally-approved waiver.

According to Medicaid: A Primer, Kaiser Family Foundation (2007), state Medicaid programs are generally required to cover:

  • Inpatient and outpatient hospital services
  • Physician, midwife, and certified nurse practitioner services
  • Laboratory and x-ray services
  • Nursing home and home health care for individuals aged 21 years and older
  • Early and periodic screening, diagnosis, and treatment (EPSDT) for children under age 21
  • Family planning services and supplies
  • Rural health clinic/ federally qualified health center services

Commonly covered optional services:

  • Prescription drugs
  • Clinic services
  • Prosthetic devices
  • Hearing aids
  • Dental care
  • Intermediate care facilities for individuals with mental retardation

State Medicaid programs must cover certain “mandatory services” enumerated infederal lawin order to receive federal matching funds. Most Medicaidbeneficiaries are entitled to receive the following services if they are determined to bemedically necessary by the state Medicaid program or a managed careorganizationwith which the state contracts:

  • Physician services
  • Hospital services (inpatient and outpatient)
  • Laboratoryandx-rayservices
  • Early and periodic screening, diagnostic, and treatment (EPSDT) services forindividuals under 21
  • Medical and surgical dental services
  • Rural and federally-qualified health center services
  • Family planning
  • Pediatric and family nurse practitioner services
  • Nurse midwife services
  • Nursing facility services for individuals 21 and older
  • Home health care for persons eligible for nursing facility services

States can choose to cover certain additional services and are entitled to receive federal matching funds for these “optional” services. Commonlyoffered optional services include:

  • Prescription drugs
  • Clinic services
  • Dental and vision services and supplies
  • Prosthetic devices
  • Physical therapy and rehab services
  • TB-related services
  • Primary care casemanagement
  • Nursing facility services forindividuals under 21
  • Intermediate care facilities for individuals with mental retardation (ICF/MR)services
  • Home-andcommunity-based careservices
  • Respiratory care services for ventilator-dependent individuals
  • Personal care services
  • Hospice services

 

 

What Services Does Medicaid Cover?