Medicaid: Medicaid: benefits and services--2005. End of Year Issue Brief

Medicaid provides health care insurance for low-income children, some parents who meet income thresholds, pregnant women, the elderly and the disabled. In order to receive federal funds for Medicaid, each state must offer coverage for the following mandatory health care services: (1) Inpatient and outpatient hospital services; (2) Physician services; (3) Medical and surgical dental services; {4) Nursing facility services; (5) Home health care services; (6) Family planning services; (7) Rural health clinic services; (8) Laboratory and x-ray services; (9) Pediatric and family nurse practitioner services; (10) Federally qualified health center services; (11) Nurse-midwife services; (12) Early and periodic screening, diagnosis and treatment (EPSDT) services for individuals under age 21 In addition to the required services mentioned above, states can also choose to cover additional services under their Medicaid plans, and these often include prescription drugs, nonmedical or surgical dental services, clinic services, and vision and hearing services. It is up to each state to decide what to include with the mandated services to create their Medicaid benefit package. Because of the variety of people to whom state Medicaid programs offer health insurance, states have gone back and forth on what services to include in their benefit packages. Some states offer extensive benefits with few restrictions on access to services, while others offer a minimal number of optional benefits. Cost, most often, is the deciding factor on whether or not to offer coverage.