Key takeaways:
Medicaid is a public health insurance program run by states and territories that provides comprehensive medical coverage to people with limited income or qualifying conditions.
Some services must be covered by Medicaid programs, but others are optional.
Check your Medicaid program website or call your local agency to find out if you have coverage for specific services.
Medicaid is a public health insurance program jointly funded by the federal government and states and territories. As of April 2026, the program served more than 66 million individuals of all ages, in addition to 7 million people enrolled in the Children’s Health Insurance Program (CHIP), which is also managed by Medicaid agencies.
In addition to eligible children and adults from households that meet income requirements, Medicaid provides coverage for pregnant women and people with qualifying conditions, including disabilities.
Below, we’ll identify more than 50 services that are typically covered by Medicaid. You can contact your state or territory Medicaid agency to learn about your specific coverage.
What services must be covered by Medicaid in all states?
The Centers for Medicare & Medicaid Services (CMS), which is part of the U.S. Department of Health and Human Services (HHS), oversees the Medicaid program. The CMS monitors state and territory Medicaid agencies to ensure compliance with federal laws.
Each state or territory determines how its program works based on federal rules that set guidelines for:
Scope of services
Service coverage
Duration of services
Service limits
Mandatory services
Although states and territories are in charge of operations, federal law requires that certain items and services are covered for all Medicaid enrollees nationwide. Below are mandatory covered services for all programs:
Certified family nurse practitioner services
Certified pediatric services
Early and periodic screening, diagnostic, and treatment (EPSDT) services
Family planning services
Federally qualified health center services
Freestanding birth center services (when licensed or otherwise recognized by the state or territory)
Home health services
Laboratory services
Nurse midwife services for pregnancy and postpartum care
Nursing facility services
Outpatient hospital services
Physician services
Tobacco-cessation counseling for pregnant women
Transportation to access covered services in emergency and nonemergency situations
X-ray services
What items and services are optional for coverage?
States and territories may choose to cover all or some of these optional items and services:
Case management
Clinic services (such as services at an urgent care or walk-in clinic)
Hearing-related services
Home and community-based attendant services
Home health services for enrollees with chronic conditions
Incontinence supplies for people who do not qualify for mandatory coverage because of their age and diagnosis
Language disorder services
Personal care services that assist with activities of daily living
Podiatry (foot) services
Preventive services
Private-duty nursing services
Prosthetics
Psychiatric services provided on an inpatient basis for people younger than age 21
Rehabilitative services
Self-directed personal assistance services
Services for individuals ages 65 and older who are in an institution for mental disease (IMD)
Services in an intermediate care facility for individuals with intellectual disabilities
Specialized diagnostic services
Speech-language pathology services
State Plan Home and Community-Based Services (HCBS)
Tuberculosis infection or disease care
Here are additional services that may be covered, depending on your state or territory:
Approved services in a religious nonmedical healthcare institution
Approved services in a critical access hospital (CAH) — a small, federally designated rural hospital
Certain mental health and substance use disorder services, as Medicaid is the largest single payer of mental health services in the U.S.
What does Medicaid not cover?
Here are some common healthcare services and items that are not typically covered by Medicaid:
Cosmetic orthodontia: Teeth-straightening procedures that are solely for aesthetic reasons may not be covered.
Elective or cosmetic procedures: Surgeries and procedures that are not medically necessary, such as cosmetic dental services and nonmedical weight-loss procedures, are typically not covered.
Fertility treatments: In vitro fertilization, artificial insemination, and other fertility treatments are typically not covered by Medicaid. Though, some states provide coverage for infertility treatments and fertility preservation under certain circumstances.
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Free and low-cost healthcare
If you need services that are not covered by Medicaid, you can search for free or low-cost healthcare in your area. Here are some resources that may be available to you:
Community clinics offering medical, dental, mental health, substance use, and other types of care in medically underserved areas
Medicare vs. Medicaid: What’s the difference in coverage?
Medicare and Medicaid are both government-sponsored health insurance programs. Both programs are monitored by the CMS.
Some people who have dual eligibility are covered by both Medicaid and Medicare. But the programs have different eligibility requirements. The table below shows some of the differences between Medicare and Medicaid.
Differences Between Medicare and Medicaid
Medicare | Medicaid |
|---|---|
Federally funded health insurance program | Jointly funded by the federal government and states and territories |
Enrollees pay premiums, deductibles, and coinsurance. | Most enrollees don’t pay monthly insurance premiums, and services are generally free or very low cost. |
Covers people ages 65 and older and younger people with certain conditions | Covers people with low or limited income, pregnant women, and people with certain conditions, such as disabilities |
There’s coverage uniformity nationwide. | Beyond mandatory coverage, benefits vary by state and territory. |
Who’s eligible for Medicaid coverage?
Medicaid eligibility is typically determined by income and/or necessity because of a qualifying condition, such as a disability. Here are two ways to find out if you qualify for Medicaid coverage:
Visit the Medicaid website for your state or territory. You can find the income guidelines for where you live and determine if you’re eligible. If there is an option to apply online, you can submit your application.
Apply for coverage through HealthCare.gov. If you apply for insurance at www.healthcare.gov, the site will help you figure out if you qualify for Medicaid or another coverage option. Otherwise, you can apply directly with your state or territory Medicaid agency.
Where can you learn more about Medicaid coverage in your state or territory?
You can learn more about Medicare coverage in your area by:
Calling 1-800-MEDICARE (1-800-633-4227) to get the phone number for your state or territory's Medicaid office
Visiting the Medicaid website for your state or territory
Medicaid in your state or territory
Below are links to information about each of the 56 local Medicaid programs.
Medicaid expansion states
The majority of states have expanded Medicaid coverage under the Affordable Care Act (ACA). That means that, in most of the country, people with higher incomes can qualify for Medicaid coverage based on income alone. If you reside in one of the 10 states below, Medicaid has not been expanded where you live:
Alabama
Florida
Georgia
Kansas
Mississippi
South Carolina
Tennessee
Texas
Wisconsin
Wyoming
Frequently asked questions
Medicaid covers many medically necessary surgeries for adults, including appendectomies, hernia repairs, gallbladder removals, joint replacements, and emergency operations.
Elective or cosmetic surgeries are generally not covered. Coverage can vary by state and territory, so it's important to check with your Medicaid plan about what services are covered and the requirements.
Medicaid covers family planning services related to birth control and reproductive health. This typically includes contraceptives, annual exams, and sexually transmitted infection (STI) testing, treatment, and counseling, in addition to sterilization procedures such as vasectomies. Fertility and infertility treatments are covered on a limited basis in some states. Coverage and eligibility can vary by state and territory, so it’s important to check with your local Medicaid office for details.
Medicaid coverage for weight-loss medications varies by state and territory. Some state Medicaid programs cover treatments such as Wegovy (semaglutide) or Contrave (naltrexone / bupropion), which are approved for weight management. However, certain plans exclude many weight-loss medications from coverage. To find out what’s covered by your plan, it’s best to check your formulary, contact your local Medicaid office, or reach out to your managed care provider.
Medicaid covers many medically necessary surgeries for adults, including appendectomies, hernia repairs, gallbladder removals, joint replacements, and emergency operations.
Elective or cosmetic surgeries are generally not covered. Coverage can vary by state and territory, so it's important to check with your Medicaid plan about what services are covered and the requirements.
Medicaid covers family planning services related to birth control and reproductive health. This typically includes contraceptives, annual exams, and sexually transmitted infection (STI) testing, treatment, and counseling, in addition to sterilization procedures such as vasectomies. Fertility and infertility treatments are covered on a limited basis in some states. Coverage and eligibility can vary by state and territory, so it’s important to check with your local Medicaid office for details.
Medicaid coverage for weight-loss medications varies by state and territory. Some state Medicaid programs cover treatments such as Wegovy (semaglutide) or Contrave (naltrexone / bupropion), which are approved for weight management. However, certain plans exclude many weight-loss medications from coverage. To find out what’s covered by your plan, it’s best to check your formulary, contact your local Medicaid office, or reach out to your managed care provider.
The bottom line
If you have a low income or limited resources and need access to health insurance, you may qualify for Medicaid. You may also be eligible if you’re pregnant or have a qualifying condition, like a disability.
Beyond items and services that must be covered under federal law, each state or territory dictates what its Medicaid program will cover. Contact the program where you live to see if you qualify for Medicaid, and what services may be available to you.
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References
Centers for Medicare & Medicaid Services. (2016). Let Medicaid give you a ride.
Healthcare.gov. (n.d.). Medicaid & CHIP: Medicaid & CHIP coverage.
KFF. (2026). Status of state action on the Medicaid expansion decision.
Medicaid.gov. (n.d.). Behavioral health services.
Medicaid.gov. (n.d.). Benefits.
Medicaid.gov. (n.d.). Inpatient psychiatric services for individuals under age 21.
Medicaid.gov. (n.d.). Mandatory & optional Medicaid benefits.
Medicaid.gov. (n.d.). Prescription drugs.
Medicaid.gov. (2026). April 2026 Medicaid & CHIP enrollment data highlights.
Ranji, U., et al. (2025). 5 key facts about Medicaid and family planning. KFF.
RESOLVE: The National Infertility and Family Building Association. (n.d.). Insurance coverage by state.
