Services Covered

More training and technical assistance materials for P&As/CAPs available in password-protected TASC section. If you do not have a username and password, please contact your Executive Director or webmaster@ndrn.org.

Page last updated: 05/26/04

Although participation in Medicaid is voluntary, once a state chooses to participate (and all states do), it must comply with federal requirements. A state must offer an extensive list of "required services" and may also choose to cover any number of "optional services." States have great leeway on what categories of service to cover.

Required Services - Certain basic services must be offered to the mandatory and categorically needy population in any state Medicaid program, including, among others: inpatient hospital services; outpatient hospital services; nursing facility services for individuals aged 21 or older; home health care for people eligible for nursing facility services; rural health clinic services; and federally-qualified health center services.

Another required Medicaid services to all Medicaid-eligible individuals under 21 years old is EPSDT. This program entitles children and adolescents to Early and Periodic Screening to identify mental health needs, Diagnosis of any needs suspected by the screen, and all appropriate medically necessary services (covered under federal Medicaid law) to Treat ("correct or ameliorate") these mental health needs. This EPSDT entitlement covers many of the services that are vital for children in need of individualized, wrap-around supports, including outpatient rehabilitation services, targeted case management and service coordination, any state home and community-based waiver service, crisis services, prescription drugs, and services of licensed professionals.

If a state chooses to include the medically needy population, the state plan must provide, as a minimum, home health services to individuals entitled to nursing facility services. States may also receive federal funding if they elect to provide other optional services, including, among others, clinic services, rehabilitation services, and prescription drugs.

Optional Services - States may also receive federal funding if they elect to provide other optional services. The most commonly covered optional services under the Medicaid program include clinic services; nursing facility services for individuals under age 21; intermediate care facility/mental retardation services; optometrist services and eyeglasses; prescribed drugs; tuberculosis (TB)-related services for people infected with TB; prosthetic devices; and dental services.