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.\
According to Medicaid: A Primer, Kaiser Family Foundation (2007), state Medicaid programs are generally required to cover:
Inpatient and outpatient hospital services
Physician, midwife, and certified nurse practitioner services
Laboratory and x-ray services
Nursing home and home health care for individuals aged 21 years and older
Early and periodic screening, diagnosis, and treatment (EPSDT) for children under age 21
Family planning services and supplies
Rural health clinic/ federally qualified health center services
Commonly covered optional services:
Prescription drugs
Clinic services
Prosthetic devices
Hearing aids
Dental care
Intermediate care facilities for individuals with mental retardation
State Medicaid programs must cover certain “mandatory services” enumerated infederal lawin order to receive federal matching funds. Most Medicaidbeneficiaries are entitled to receive the following services if they are determined to bemedically necessary by the state Medicaid program or a managed careorganizationwith which the state contracts:
Physician services
Hospital services (inpatient and outpatient)
Laboratoryandx-rayservices
Early and periodic screening, diagnostic, and treatment (EPSDT) services forindividuals under 21
Medical and surgical dental services
Rural and federally-qualified health center services
Family planning
Pediatric and family nurse practitioner services
Nurse midwife services
Nursing facility services for individuals 21 and older
Home health care for persons eligible for nursing facility services
States can choose to cover certain additional services and are entitled to receive federal matching funds for these “optional” services. Commonlyoffered optional services include:
Prescription drugs
Clinic services
Dental and vision services and supplies
Prosthetic devices
Physical therapy and rehab services
TB-related services
Primary care casemanagement
Nursing facility services forindividuals under 21
Intermediate care facilities for individuals with mental retardation (ICF/MR)services
Home-andcommunity-based careservices
Respiratory care services for ventilator-dependent individuals