What services does Medicaid cover?
Medicaid is required by federal law to require certain services. These include:
- Inpatient hospital
- Outpatient hospital
- Early periodic screening, diagnosis, and treatment (EPSDT)
- Nursing facility
- Home health
- Rural health clinic
- Federally qualified health center
- Laboratory and X-ray
- Family planning
- Nurse midwife
- Certified pediatric and family nurse practitioner
- Freestanding birth center (when licensed or otherwise recognized by the state)
- Transportation to medical care
- Tobacco cessation and tobacco cessation counseling for pregnant women and youth under 21
States are also given the option of covering other services. These include:
- Prescription drugs*
- Physical therapy
- Occupational therapy
- Speech, hearing, and language disorder therapy
- Respiratory care
- Other diagnostic, screening, preventive, and rehabilitative care
- Other practitioner
- Private duty nursing
- Personal care
- Case management
- Services for individuals aged 65 years or older in an institution for mental diseases
- Intermediate care facility for the developmentally disabled
- State Plan home and community-based care (under §1915(i))
- Self-directed personal assistance (under §1915(j))
- Community First Choice Option (under §1915(k))
- Tuberculosis-related care
- Inpatient psychiatric care for individuals younger than 21 years
- Other Secretary-approved care
If you want to know which optional services your state covers, you should contact your state Medicaid department.
It is important to note that all states currently provide coverage for outpatient prescription drugs to all categorically eligible individuals and most other enrollees within their Medicaid programs.
Resource: Medicaid Enrollment By State
Does Medicaid cover my factor, HTC, other doctors, etc.?
- You will have to contact your Medicaid department to determine whether your healthcare providers and preferred pharmacy are in your Medicaid program’s “network”.
Disclaimer. This website is a resource only and should be used for information purposes. Please work with your health care providers, insurance councilors, etc. to determine the best solution for you.