Key takeaways:
Medicaid is a federal and state program that provides benefits to individuals with low income who lack health insurance or don’t have sufficient coverage.
Some Medicaid benefits are mandatory for each state, but others are optional.
Check your state website to find out if you qualify for specific services and benefits.
Medicaid is a joint federal and state medical assistance program created in 1965. As of April 2023, the program served more than 87 million low-income individuals and families. Enrollment in Medicaid has increased roughly 33% since February 2020.
The program has helped eligible children, adults, pregnant women, and people with disabilities gain access to free or low-cost health insurance.
Below, we’ll identify 50 services and benefits typically covered by Medicaid. You can also contact your state Medicaid department to see a full list of services that are covered in your area.
Which Medicaid benefits and services are mandatory in all states?
The Centers for Medicare & Medicaid Services (CMS) oversees the Medicaid program. The agency is part of the U.S. Department of Health and Human Services (HHS). CMS monitors state programs to ensure compliance with federal laws.
Each state is responsible for establishing and managing their own Medicaid program. States determine the following based on federal guidelines:
Scope of services
Service coverage
Duration of services
Service limits
Although states establish their own programs, federal law still requires certain mandatory benefits for Medicaid beneficiaries. Below are 18 mandatory services that are required no matter which state you live in:
Certified family nurse practitioner services
Certified pediatric services
Early and periodic screening, diagnostic, and treatment services (EPSDT)
Family planning services
Federally qualified health center services
Freestanding birth center services (when licensed or otherwise recognized by the state)
Home health services
Laboratory services
Nurse midwife services for pregnancy and postpartum care
Nursing facility services
Outpatient hospital services for medically necessary treatment provided under the care of a physician
Physician services
Pregnancy-related services
Rural health clinic services
Tobacco-cessation counseling for pregnant women
Transportation to medical care for emergency and non-emergency situations for eligible individuals
X-ray services
Which Medicaid benefits and services are optional?
States may choose if they offer certain services under their Medicaid programs. Here are 35 optional benefits and services:
Case management
Chiropractic services
Clinic services (urgent care clinic, walk-in clinic, etc.)
Community First Choice option 1915(k)
Diagnostic services
Eyeglasses
Health Homes for enrollees with chronic conditions
Hearing services
Language disorder services
Other practitioner services
Personal care services that assist with activities of daily living
Podiatry (foot) services
Preventive services
Private-duty nursing services
Psych under 21 (inpatient psychiatric services for individuals under age 21)
Rehabilitative services
Screening services
Self-directed personal assistance services 1915(j)
Services for individuals age 65 or older in an institution for mental disease (IMD)
Services in an intermediate care facility for individuals with intellectual disabilities
Speech-language pathology services
State Plan home and community-based services 1915(i)
Tuberculosis (TB) services for the care of TB infection or disease
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Additional services and benefits that may be provided depending on your state include:
Approved services in a religious nonmedical healthcare institution
Approved services in a critical access hospital (CAH)
Medicaid programs also cover mental health and substance use disorder services. The type of services covered will depend on your state.
What does Medicaid not cover?
Medicaid coverage can vary from state to state, but here are some common services and items that are typically not covered:
Elective cosmetic procedures: Cosmetic surgeries and procedures, such as cosmetic dentistry and non-medical weight loss procedures, that are not medically necessary are typically not covered.
Cosmetic orthodontia: Teeth straightening procedures that are solely for aesthetic reasons may not be covered.
Non-emergency transportation: If you need to go to the doctor for a regular medical appointment, you may not receive Medicaid coverage for traveling to the appointment in some states.
Fertility treatments: In-vitro fertilization, artificial insemination, and other fertility treatments are typically not covered by Medicaid. However, New York provides Medicaid coverage for medically necessary fertility medications and Illinois covers egg or sperm preservation for certain individuals.
Medicare vs. Medicaid: What’s the difference in coverage?
Medicare and Medicaid are both government-sponsored medical insurance programs in the U.S. They are monitored and administered by the Centers for Medicare & Medicaid Services and provide assistance for people with disabilities.
But the programs’ qualifications are different. The table below shows some of the differences between Medicare and Medicaid.
Medicare | Medicaid |
Federal health insurance program | Joint federal and state medical assistance program |
Patients pay premiums, deductibles, and coinsurance | No monthly insurance premiums, and services are generally free. There may be a small fee for certain services. |
Helps people over age 65 | Helps people with low income |
Programs are the same nationwide | Benefits and services vary from state to state |
Who’s eligible for Medicaid coverage?
Medicaid eligibility is typically based on income and family size. Here are two ways to find out if you qualify:
Visit your state’s Medicaid website. You can find the income guidelines for your state and verify your eligibility on the website. If there is an option to apply online, you can submit your application.
Complete an application on healthcare.gov using the health insurance marketplace. You’ll find out if you qualify for Medicaid or savings on a marketplace plan.
Where can you learn more about Medicaid coverage in your state?
You can learn more about Medicare coverage in your state by:
Calling 1-800-MEDICARE (1-800-633-4227) to get the phone number for your state's Medicaid office
Visiting your state website
Going to Kaiser Family Foundation’s website to access the database of benefits by service type and state
Below are the links to information about each state’s Medicaid program:
Some states have expanded Medicaid coverage under the Affordable Care Act (ACA). This means that more low-income individuals can gain access to health insurance based on income alone. If you are in one of the 10 states below, your state did not expand Medicaid coverage:
Alabama
Florida
Georgia
Kansas
Mississippi
South Carolina
Tennessee
Texas
Wisconsin
Wyoming
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 organizations and resources that may be available to you:
The bottom line
If you are low income and need access to healthcare, you may qualify for Medicaid. Each state has its own requirements and covered services. Call your state office or review their website to see if you qualify for Medicaid, and what services may be available to you.
Why trust our experts?
References
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Benefits.gov. (n.d.). Florida Medicaid.
Centers for Medicare & Medicaid Services. (n.d.). About CMS.
Centers for Medicare & Medicaid Services. (2016). Let Medicaid give you a ride.
Centers for Medicare & Medicaid Services. (2016). Medicaid non-emergency medical transportation booklet for providers.
Division of TennCare. (n.d.). TennCare Medicaid.
Georgia Medicaid. (n.d.). Homepage.
Illinois.gov. (2018). Gov. Rauner extends health insurance to fertility preservation.
Kaiser Family Foundation. (2023). Status of state action on the Medicaid expansion decision.
Healthcare.gov. (n.d.). Find out if you can still get health coverage.
Healthcare.gov. (n.d.). Homepage.
Medicaid.gov. (n.d.). Benefits.
Medicaid.gov. (n.d.). Inpatient psychiatric services for individuals under age 21.
Medicaid.gov. (n.d.). Mandatory and optional Medicaid benefits.
Medicaid.gov. (n.d.). Medicaid.
Medicaid.gov. (n.d.). Medicaid and CHIP enrollment trend snapshot.
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Medicaid.gov. (n.d.). Program history.
Medicaid.gov. (n.d.). Seniors and Medicare and Medicaid enrollees.
Medicaid for Kansas. (n.d.). What is KanCare?
Mississippi Division of Medicaid. (n.d.). Homepage.
North Carolina Medicaid Division of Health Benefits. (n.d.). Beneficiaries.
South Carolina Department of Health and Human Services. (n.d.). Getting started.
South Dakota Department of Social Services. (n.d.). Medicaid expansion.
Texas Health and Human Services. (n.d.). Medicaid and CHIP.
Texas Health and Human Services. (n.d.). Personal care services.
Wisconsin Department of Health Services. (2023). Medicaid in Wisconsin.
Wyoming Department of Health. (n.d.). Wyoming Medicaid.
