Medicaid Benefits - Mandatory & Optional State Benefits

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Mandatory & Optional Medicaid Benefits

Medicaid is a joint federal and state run program that allows all states to both establish and provide their own Medicaid programs. This means the states themselves determine the type, duration, amount and spectrum of services that they provide, though they must stay within the federal guidelines of the Medicaid program. 

All states are required to provide certain Medicaid benefits under federal law. States may also chose to cover select benefits as well which are known as "optional benefits". Optional benefits vary from state to state. For instance, one state may decide to limit the amount of inpatient hospital days Medicaid covers each year, while another state may allow for an unlimited amount of inpatient days an enrollee is allowed. 

You will find the mandatory and optional benefits offered by Medicaid in the guide below. 

*Note. Some of these items may have been updated and/or changed by state. You can check with your individual state agency to find out what your state's optional benefits may include.

Mandatory Benefits

Optional Benefits

Inpatient Hospital Services

Prescription Drugs
Outpatient Hospital ServicesClinic Services
EPSDT: Early and Periodic Screening, Diagnostic and Treatment ServicesPhysical Therapy
Nursing Facility ServicesOccupational Therapy
Home Health ServicesSpeech/Hearing Language disorder Services
Physician ServicesRespiratory Care Services
Rural Health Clinic ServicesDiagnostic/Screening and Preventive and Rehabilitative Services

Federally Qualified Health Center Services

Podiatry Services
Laboratory and X-ray ServicesOptometry Services
Family Planning ServicesDental Services
Nurse Midwife ServicesDentures
Certified Pediatric and Family Nurse Practitioner ServicesProsthetics
Freestanding Birth Center Services (licensed or recognized)Eyeglasses
Transportation to Medical CareChiropractic Services
Tobacco Cessation Counseling for Pregnant WomenCertain Practitioner Services
Private Duty Nursing Services
Personal Care
Hospice
Case Management
Services for Individuals 65 and older in Institution for Mental Disease
Services in an Intermediate Care Facility for Individuals with Intellectual Disability
State Plan Home and Community Based Services
Self Directed Personal Assistance Services
Community First Choice Option
TB Related Services
Inpatient Psychiatric Services for Individuals Under Age 21
Other Services Approved by the Secretary
health Homes for Enrollees with Chronic Conditions


 

Can I Have Both Medicaid & Medicare Benefits?

In short, yes, you can be covered and receive benefits by both programs. Both Medicaid and Medicare are similar in that they both provide medical coverage for low income individuals and families, as well as individuals with certain medical conditions and in select scenarios. When it comes to the benefits of either program however, they differ in some ways and can both be separately beneficial to you.

If you are enrolled for coverage in both Medicaid and Medicare simultaneously, Medicare will generally cover most of your medical needs and services. Though if you have medical needs that are not covered by Medicare, you can seek to have them covered by your state's Medicaid program. 

Another difference concerning out-of-pocket expenses for someone who is covered by both Medicare or Medicaid is that Medicare does not always pay the entirety of a medical bill, even if the medical service is covered as such. This means that if your Medicare Part A or Part B leaves part of your medical bill unpaid, your Medicaid may step in to cover the remainder of the medical services bill. Your Medicaid coverage my also pay for prescription drugs that are not covered by your Medicare Part D coverage.

How Long Will My Medicaid Benefits Last?

Your Medicaid benefits will be active as long as you remain eligible for Medicaid and have taken the appropriate steps to remain covered. If you have recently had a life-altering event take place that changes your finances in either direction, you should contact your state Medicaid agency within 10 days to discuss the change. They will tell you the appropriate steps to take to remain covered by Medicaid.

Medicaid & Coronavirus

Medicaid has now become a lifeline to many Americans suffering with the coronavirus and other illnesses during the pandemic. The situation has caused millions of people to file for unemployment thus ending their employment medical coverage, which then leaves them with enrolling for Medicaid coverage for the time being. 

The Department of Health and Human Services has deemed coronavirus testing an essential health benefit, thus Medicaid will cover costs of testing for coverage beneficiaries that are suspected of having the virus. In order for Medicaid to cover the cost of testing, your doctor must first order it and administer the test for you.

State run Medicaid programs are allowed to rapidly expand their coverage benefits and allowances when the situation becomes overwhelming, such as with the coronavirus pandemic. States are allowed the flexibility to decide to cover the costs of treatment in non-traditional settings, such as with Telemedicine and Telehealth services. The flexibility also allows states to cover any new vaccines that become available in the future.

Medicaid has also changed a bit to account for the coronavirus outbreak and now includes coverage of the following coronavirus related items :

  • Lab tests for COVID-19.
  • Telehealth services for diagnosing and treating COVID-19, regular office visits, mental health counseling, and preventive health screenings. 
  • All medically necessary hospitalizations will be covered. 
  • Any future vaccine may be covered. (Individual states will have the option to provide any future vaccine with or without a co-pay under current rules.)

Obamacare:
People who were receiving health insurance through their employer and were laid off due to the coronavirus (COVID-19) pandemic are eligible to take advantage of a Special Enrollment Period to receive health insurance under Obamacare. 

Please note that not all states have the same guidelines and benefits for coverage. Check with your local Medicaid state agency to determine if you are covered for a specific situation. All states and their respective Medicaid websites are listed in the table below:

State                

Website
AlabamaInsure Alabama
AlaskaDHSS Alaska
ArizonaHealth-e-Arizona Plus website
Arkansas Access.Arkansas.gov
CaliforniaCovered California
ColoradoColorado PEAK 
ConnecticutConnectCT 
Delaware Delaware Assist
District of ColumbiaDC Health Link
FloridaAccess Florida
GeorgiaGeorgia Gateway
HawaiiMedQuest Hawaii
IdahoIdaho Health and Welfare
IllinoisGetCoveredIllinois
IndianaIn.gov
IowaIowa Department of Human Services
KansasKanCare
KentuckyKynect
LouisianaLouisiana DOH
MaineMy Maine Connection
MarylandMaryland Health Connection
Massachusetts MAhealthconnector.org
MichiganMIBridges
MinnesotaMNSure
Mississippimedicaid.ms.gov
MissourimyDSS
Montanaapply.mt.gov
NebraskaACCESSNebraska
NevadaAccess Nevada
New HampshireNH Easy Gateway to Services
New JerseyNJ FamilyCare
New MexicoYesNewMexico
New YorkNY State of Health
North CarolinaNCDHHS
North DakotaNDDOH
OhioOhio Benefits
OklahomaOKHCA
OregonOregon.gov
PennsylvaniaCOMPASS
Rhode IslandHealth Source
South CarolinaHealthy Connections
South DakotaSouth Dakota DSS
TennesseeDivision of TennCare
TexasYourTexasBenefits
UtahUtah Department of Workforce Services
VermontVermont Health Connect
VirginiaCover Virginia
WashingtonWashington Healthplanfinder
West VirginiainROADS
WisconsinWisconsin Access
WyomingWyoming DOH


Medicaid Health Insurance Guides

Benefit Guide About
Medicaid EligibilityIncome requirements to receive medicaid health insurance in your state
Medicaid ApplicationTips & advice on applying for Medicaid health insurance
Medicaid BenefitsRead the GuideThe current article you are reading
Government Benefits GuidesLists of most common government benefits, requirements to qualify and how to apply

Medicaid Health Insurance Guides

Benefit Guide About
Medicaid EligibilityIncome requirements to receive medicaid health insurance in your state
Medicaid ApplicationTips & advice on applying for Medicaid health insurance
Medicaid BenefitsRead the GuideThe current article you are reading
Government Benefits GuidesLists of most common government benefits, requirements to qualify and how to apply