Federal Medicaid rules allow states flexibility to design their own benefit packages beyond meeting core federal requirements. These requirements specify 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. Beyond these minimum requirements, states have discretion in choosing which services to offer and the scope and range of the services. A list of mandatory and optional benefits is available here, and federal definitions of these benefits are available here.
Institutional and Clinic Services
- Medicaid Benefits: Inpatient Hospital Services, other than in an Institution for Mental Disease View details about Medicaid Benefits: Inpatient Hospital Services, other than in an Institution for Mental Disease
- Medicaid Benefits: Outpatient Hospital Services View details about Medicaid Benefits: Outpatient Hospital Services
- Medicaid Benefits: Rural Health Clinic Services View details about Medicaid Benefits: Rural Health Clinic Services
- Medicaid Benefits: Federally Qualified Health Center Services View details about Medicaid Benefits: Federally Qualified Health Center Services
- Medicaid Benefits: Clinic Services (Excluding Mandatory FQHC and RHC Services) View details about Medicaid Benefits: Clinic Services (Excluding Mandatory FQHC and RHC Services)
- Medicaid Benefits: Freestanding Birth Center Services View details about Medicaid Benefits: Freestanding Birth Center Services
Practitioner Services
- Medicaid Benefits: Physician Services View details about Medicaid Benefits: Physician Services
- Medicaid Benefits: Medical/Surgical Services of a Dentist View details about Medicaid Benefits: Medical/Surgical Services of a Dentist
- Medicaid Benefits: Nurse Midwife Services View details about Medicaid Benefits: Nurse Midwife Services
- Medicaid Benefits: Nurse Practitioner Services View details about Medicaid Benefits: Nurse Practitioner Services
- Medicaid Benefits: Dental Services View details about Medicaid Benefits: Dental Services
- Medicaid Benefits: Podiatrist Services View details about Medicaid Benefits: Podiatrist Services
- Medicaid Benefits: Optometrist Services View details about Medicaid Benefits: Optometrist Services
- Medicaid Benefits: Chiropractor Services View details about Medicaid Benefits: Chiropractor Services
- Medicaid Benefits: Psychologist Services View details about Medicaid Benefits: Psychologist Services
Prescription Drugs
- Medicaid Benefits: Prescription Drugs View details about Medicaid Benefits: Prescription Drugs
- Medicaid Benefits: Over-the-Counter Products View details about Medicaid Benefits: Over-the-Counter Products
- Medicaid Benefits: Tobacco Cessation Products (Other Than As Required For Pregnant Women) View details about Medicaid Benefits: Tobacco Cessation Products (Other Than As Required For Pregnant Women)
Physical Therapy and Other Services
- Medicaid Benefits: Physical Therapy Services View details about Medicaid Benefits: Physical Therapy Services
- Medicaid Benefits: Occupational Therapy Services View details about Medicaid Benefits: Occupational Therapy Services
- Medicaid Benefits: Services for Speech, Hearing and Language Disorders View details about Medicaid Benefits: Services for Speech, Hearing and Language Disorders
Products and Devices
- Medicaid Benefits: Dentures View details about Medicaid Benefits: Dentures
- Medicaid Benefits: Prosthetic and Orthotic Devices View details about Medicaid Benefits: Prosthetic and Orthotic Devices
- Medicaid Benefits: Eyeglasses and Other Visual Aids View details about Medicaid Benefits: Eyeglasses and Other Visual Aids
- Medicaid Benefits: Hearing Aids and Other Hearing Devices View details about Medicaid Benefits: Hearing Aids and Other Hearing Devices
- Medicaid Benefits: Medical Equipment and Supplies (Other Than Through Home Health) View details about Medicaid Benefits: Medical Equipment and Supplies (Other Than Through Home Health)
Transportation Services
Other Services
- Medicaid Benefits: Laboratory and X-Ray Services, outside Hospital or Clinic View details about Medicaid Benefits: Laboratory and X-Ray Services, outside Hospital or Clinic
- Medicaid Benefits: Family Planning Services View details about Medicaid Benefits: Family Planning Services
- Medicaid Benefits: Diagnostic, Screening and Preventive Services View details about Medicaid Benefits: Diagnostic, Screening and Preventive Services
- Medicaid Benefits: Rehabilitation Services – Mental Health and Substance Use View details about Medicaid Benefits: Rehabilitation Services – Mental Health and Substance Use
- Medicaid Benefits: Case Management View details about Medicaid Benefits: Case Management
- Medicaid Benefits: Targeted Case Management View details about Medicaid Benefits: Targeted Case Management
- Medicaid Benefits: ACA Health Home View details about Medicaid Benefits: ACA Health Home
- Medicaid Benefits: Other Medical or Remedial Care – Hygienists or Dental Assistants View details about Medicaid Benefits: Other Medical or Remedial Care – Hygienists or Dental Assistants
- Medicaid Benefits: Other Medical or Remedial Care – Physician Assistants View details about Medicaid Benefits: Other Medical or Remedial Care – Physician Assistants
Long-Term Care: Home and Community Based Care
- Medicaid Benefits: Home Health Services – Nursing Services, Home Health Aides, and Medical Supplies/Equipment View details about Medicaid Benefits: Home Health Services – Nursing Services, Home Health Aides, and Medical Supplies/Equipment
- Medicaid Benefits: Home Health Services – Physical Therapy, Occupational Therapy, and/or Speech Pathology/Audiology View details about Medicaid Benefits: Home Health Services – Physical Therapy, Occupational Therapy, and/or Speech Pathology/Audiology
- Medicaid Benefits: Private Duty Nursing Services View details about Medicaid Benefits: Private Duty Nursing Services
- Medicaid Benefits: Hospice Care View details about Medicaid Benefits: Hospice Care
- Medicaid Benefits: Personal Care Services View details about Medicaid Benefits: Personal Care Services
- Medicaid Benefits: Self-Directed Personal Assistance Services View details about Medicaid Benefits: Self-Directed Personal Assistance Services
- Medicaid Benefits: Program of All-Inclusive Care for the Elderly (PACE) View details about Medicaid Benefits: Program of All-Inclusive Care for the Elderly (PACE)
Long-Term Care: Institutional Care
- Medicaid Benefits: Nursing Facility Services, Other Than in an Institution for Mental Disease, Age 21+ View details about Medicaid Benefits: Nursing Facility Services, Other Than in an Institution for Mental Disease, Age 21+
- Medicaid Benefits: Services in Institutions for Mental Disease, Age 65 and Older View details about Medicaid Benefits: Services in Institutions for Mental Disease, Age 65 and Older
- Medicaid Benefits: Intermediate Care Facility Services for Individuals with Intellectual Disabilities View details about Medicaid Benefits: Intermediate Care Facility Services for Individuals with Intellectual Disabilities
About this Data Collection
Federal Medicaid rules allow states flexibility to design their own benefit packages beyond meeting core federal requirements. These requirements specify 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. Beyond these minimum requirements, states have discretion in choosing which services to offer and the scope and range of the services. A list of mandatory and optional benefits is available here, and federal definitions of these benefits are available here.
The Kaiser Family Foundation (KFF) contracted with Health Management Associates (HMA) to survey Medicaid directors in all 50 states and the District of Columbia to identify those benefits covered for adult beneficiaries in their programs. The resulting data collection updates previous years of KFF Medicaid benefits data (data from 2012 and previous years remain accessible through drop down menus in most of the indicators below). The survey instrument was designed to capture information about benefits covered, cost sharing requirements, and notable limits on those benefits as of July 1, 2018. The 2018 survey asked states to report coverage of benefits in their fee-for-service (FFS) programs for categorically needy (CN) traditional Medicaid adults ages 21 and older. Unlike in previous years, the 2018 survey did not ask about benefit coverage for medically needy (MN) coverage groups. All but four states (Illinois, Iowa, New York, and South Carolina) submitted survey responses, and the territories are not included in the 2018 data. For additional notes and methods information and a summary table with national counts of states covering each benefit, click here. For data on Medicaid coverage of a range of behavioral health services by state, see the Medicaid Behavioral Health Services Database.