What does Medicaid cover?
Medicaid helps millions of people in the U.S. pay for essential healthcare services, including Americans with low incomes, disabilities, high medical bills, or chronic health conditions.
What Medicaid covers, and who gets certain benefits, can vary depending on your state, your age, and the type of Medicaid plan you have.
All states must cover certain basic health services under federal law, but many also offer optional benefits like dental, vision, or therapy services as part of Medicaid. In general, children and teens receive broader coverage under Medicaid than adults, especially for preventive and dental care.
Here’s a breakdown of what Medicaid is required to cover, which benefits some states choose to add, and how coverage differs for children and adults.
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What services is Medicaid required to cover under federal rules?#what-services-is-medicaid-required-to-cover-under-federal-rules
Under federal law, every state’s Medicaid program must provide certain benefits. These are services everyone with Medicaid, both adults and children, can access. The amount of coverage may vary by state and health plan.
Required services for all Medicaid members include:
- Doctor visits (outpatient care): When you visit a doctor’s office to receive preventive, diagnostic, therapeutic, rehabilitative, or palliative services
- Hospital care: When you are admitted to or stay overnight in a hospital
- Rural health clinic and federally qualified health center services: When you need services from a qualified provider at a rural health clinic or federally-qualified health center
- Emergency room visits: When you visit the emergency room for emergencies and non-emergencies, although copays may apply
- Lab tests and X-rays: When you need routine or diagnostic lab tests or X-rays
- Nursing home or assisted living services (for those who qualify): When you need assisted living services, Medicaid may cover some, but not all of the costs
- Home health care services (for those who qualify): When you need assistance at home, including skilled nursing, home health aides, and medical supplies, equipment, and appliances
- Family planning services and care during pregnancy and childbirth: When you need family planning services or other services (including birth centers and counseling to help pregnant people quit tobacco)
- Medication Assisted Treatment (MAT): When you need medication for substance-use disorders in addition to counseling services and behavioral therapy related to treatment
- Routine costs for approved clinical trials: When you participate in a qualifying clinical trial, Medicaid will cover items or services provided to prevent, diagnose, monitor, or treat complications resulting from participation in the qualifying clinical trial
- Transportation to access covered services: When you have no other means of transportation and need emergency or non-emergency medical transportation to receive covered care
What additional services does Medicaid have to cover for children?#what-additional-services-does-medicaid-have-to-cover-for-children
Under federal rules, children and teens under 21 have special coverage through a program called EPSDT, short for Early and Periodic Screening, Diagnostic, and Treatment.
EPSDT requires states to cover any service that’s medically necessary to correct or improve a child’s physical or mental health condition, even if that service isn’t normally covered for adults.
Additional services provided to children through EPSDT include:
- Regular well-child visits: Routine health checkups to monitor growth, development, and overall well-being
- Developmental and behavioral screenings: Assessments that help identify learning, emotional, or behavioral challenges as early as possible
- Vision care: Eye exams, diagnosis, and eyeglasses when needed to ensure healthy vision and school readiness
- Hearing care: Hearing tests and hearing aids if needed, so children with hearing loss can develop strong communication and learning skills
- Dental care: Dental care needed for relief of pain, infection, restoration of teeth, maintenance of dental health (provided at as early an age as necessary), and medically necessary orthodontic services
- Immunizations and vaccines: Coverage for all age-appropriate vaccines as recommended by the Advisory Committee on Immunization Practices
- Diagnostic care: Services, tests, and care related to diagnosis of conditions
In addition, children can receive:
- Hospice care, alongside other treatment
- Certified pediatric and family nurse practitioner services
What other benefits do some states or Medicaid plans cover?#what-other-benefits-do-some-states-or-medicaid-plans-cover
Beyond the federal requirements, states can choose to cover optional benefits for adults, and many do. These extra services vary widely from one state to another.
Additional Medicaid benefits may include (but are not limited to):
- Prescription drugs: Technically optional under federal law, but all states currently cover them
- Dental care: Many states cover dental services for adults, but the scope can vary (some cover only emergency care, while others include routine cleanings or dentures)
- Vision care: Some states cover annual eye exams and glasses for adults, while others limit coverage to children
- Hearing services: Such as exams or hearing aids
- Physical, occupational, or speech therapy
- Behavioral health and psychiatric care
- Chiropractic or podiatry care
- Hospice care
