What benefits do states have to provide to enrollees?
A. Medicaid benefits are divided into two categories—”mandatory” and “optional.” Mandatory benefits are services that states must cover. These include, for example, inpatient and outpatient hospital services, physician services, and lab and x-ray services. States can choose whether to provide optional services. However, many “optional” benefits are actually essential to the health of enrollees. For example, prescription drugs and many mental health services are considered “optional” services under Medicaid, even though they are critical health services to individuals for whom they are medically necessary. When a state decides to cover an optional service, it generally must make that service available to all the groups that the state’s Medicaid program covers (both mandatory and optional groups). However, with the passage of the Deficit Reduction Act (DRA), states now have the option to change their benefit packages so that not all groups must be offered the same benefits. You can read
