What Kind of Services Are Covered in Medicaid?

Medicaid is a health program and a single largest health coverage in United States. It covers the health problems of all demographics including children, pregnant women, parents, seniors, and individuals with disabilities. Together with CHIP (Children’s Health Insurance Program), Medicaid covers almost all low-income American families under age 65. To qualify for Medicaid coverage, a person must make less than 133 percent of the federal poverty line, which is about $16,000 for an individual or about $32,000 for a family of four.  

There are mandatory benefits and services of Medicaid under federal law such as, inpatient hospital services, outpatient hospital services, Early and Periodic Screening, Diagnostic and Treatment Services, nursing facility services, home health services, physician services, rural health clinic services, federally qualified health center services, laboratory and X-ray services, family planning services, nurse midwife services, certified pediatric and nurse practitioner services, freestanding birth center services (when licensed or otherwise recognized by the state), transportation to medical care, and tobacco cessation counseling for pregnant women.

Some of the optional benefits and services provided by Medicaid are, prescription drugs, clinic services, physical therapy, occupational therapy, speech, hearing and language disorder services, respiratory care services, other diagnostic, screening and rehabilitative services, podiatry services, optometry services, Medicaid dental coverage, dentures, prosthetics, eyeglasses, chiropractic services, other practitioner services, private duty nursing services, personal care, hospice, Case management, services for individuals age 65 or older in an institution for mental disease, services for 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, and other Inpatient psychiatric services for individuals under age 21.

Other services approved by the Secretary including services furnished in a religious nonmedical health care institution, emergency hospital services by a non-Medicare certified hospital, and critical access hospital (CAH).

The coverage of these services vary from state to state in the case of the optional benefits by Medicaid. For example, in Nevada, the Medicaid facility includes the services like, ambulance/transportation, birth control/family planning, Medicaid Dental Coverage, disposable medical supplies, durable medical equipment, orthotics & prosthetics, doctor visits, emergency room, eye exams and eyeglasses, hospice care, hearing tests, preventive health services for children, home based habilitation services (HBHS) and many more.

Moreover, in Texas, they provide traditional Medicaid services for those who can’t manage to be the part of the in-care services. These include the programs like STAR and STAR Kids which give the services for children which are also called managed care plans. In addition to that, there is STAR Health coverage for children and young adults who were previously in the foster care facilitates. This coverage includes benefits like dentist visits, cleanings, and fillings, eye exams and glasses, choice of doctors, regular checkups, and office visits, prescription drugs and vaccines, access to medical specialists and mental health care.

Although, there are some services that are not included under the Medicaid such as VSG (vertical sleeve gastrectomy) and other weight loss surgeries. That is why you should confirm within your state that which services Medicaid provides you and avail them with complete responsiveness.

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