What services does Medicaid cover?
Title XIX of the Social Security Act allows states considerable flexibility to craft their Medicaid plans. The benefit package is defined by each state based on broad federal guidelines. There is much variation among state Medicaid programs regarding the definition of services and the amount of services provided. However, some services must be covered in order for the state to receive federal matching funds. Mandatory services for categorically needy populations include the following. · Inpatient hospital services, · Outpatient hospital services, · Physician services and medical and surgical services of a dentist, · Nursing facility services and home health services for those aged 21 or older, · Family planning services and supplies, · Rural health clinic and federally qualified health center (FQHC) services, · Laboratory and x-ray services, · Nurse practitioner services, · Nurse-midwife services, and · Early and periodic screening, diagnostic and treatment (EPSDT) services for childre
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.
