What Costs Are Not in Covered by Medicaid When Seeing a Doctor?


Quick Answer

Although Medicaid programs vary by state, every state is required to provide mandatory benefits to Medicaid recipients, including inpatient and outpatient hospital services, home-health services, early and periodic screening, diagnostic and treatment services, and physician services. Labs, X-rays, family planning, nurse midwife and birth-center services are also mandatory.

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Full Answer

Rural health-clinic services, federally qualified health-center services, certified pediatric and family nurse-practitioner services, transportation to medical care and tobacco cessation counseling for pregnant women are also required under the mandatory services guidelines for all states, as of 2015.

Optional services that can be covered by Medicaid but that are not required under federal guidelines are determined by each state. This means that some states offer these benefits to Medicaid recipients while others do not. Some examples of optional benefits include prescription drugs, clinic services, occupational therapy, physical therapy, respiratory-care services, podiatry services and optometry services. Dental services, dentures, eyeglasses, prosthetics, chiropractic services and private-duty nursing services are also optional, as are hospice care, personal care and case management.

In addition, Medicaid in most states covers services for individuals age 65 or older in an institution for mental disease. These services, which are collectively referred to as IMD over 65, covers the cost for patients diagnosed with a mental illness residing in a hospital or nursing facility.

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