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Medicaid Benefits Data Collection

This data collection reflects Medicaid benefits covered in each state, limitations applied to those benefits, cost-sharing charges, and the reimbursement methodologies used for those benefits in effect at six specific points in time, the most recent being October 1, 2012. In general, the data presented here represents a state’s policies applicable to adult Medicaid beneficiaries receiving care on a “fee for service” basis.

More information about the methods and who to contact information is included at the bottom of this page in the About the Data Collection section.

Institutional and Clinic Services

Practitioner Services

Prescription Drugs

Physical Therapy and Other Services

Products and Devices

Transportation Services

Other Services

Long-Term Care: Home and Community Based Care

Long-Term Care: Institutional Care

about this data collection
General Information - About Medicaid Benefits. The Medicaid benefits package is broad and flexible. Its breadth reflects the differing needs of the various populations that Medicaid serves, many of which have more serious health needs than the general population. Federal Medicaid laws and regulations have historically allowed states, the District of Columbia and the five US territories substantial flexibility to design their own benefits packages subject to certain minimum requirements. These requirements specified certain mandatory services that each state’s Medicaid program must provide, that the services be adequate in amount, duration and scope, and that coverage not vary according to an individual’s diagnosis or condition. However, beyond these minimum requirements, states have had discretion in choosing which services to offer and the scope and range of the services.

Methodology. These tables reflect services, limitations and reimbursement methodologies in effect at six specific points in time – January 1, 2003, October 1, 2004, October 1, 2006, October 1, 2008, October 1, 2010, and October 1, 2012. For each point in time, there are tables for all 50 states, the District of Columbia and the five U.S. territories: American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the Virgin Islands. The source documents were Medicaid State Plans and State Plan amendments submitted to and approved by the Centers for Medicare & Medicaid Services (CMS). Additional information was obtained from state web sites.

Additional Information. From this information, state-specific summaries were prepared by Esther Reagan at Health Management Associates and sent to Medicaid officials in the respective jurisdictions for validation.  Notes on the structure of the database, with definitions and acronyms used throughout the database and providing special information about selected benefits are included on companion documents attached to the database.  Please contact Laura Snyder at the Kaiser Commission on Medicaid and the Uninsured with any questions.