What Does Medicaid Cover In 2023?
Posted in Uncategorized last updated on December 12, 2022Even though Medicaid is a federally-funded program, what is covered by Medicaid varies from state to state because state governments also partially fund the program. If you have been trying to get a clear idea of the Medicaid benefits available to you in your state of residence, you have come to the right place!
The Medicaid program in each state is required to meet a list of mandatory requirements, which the federal government puts forth. Once these minimums are met, it is up to the state to decide how much more, if any, they will provide in their Medicaid program.
Some states choose to provide just what is federally mandatory, without any additions. The majority of other states have opted to expand Medicaid benefits to include more areas of healthcare and provide these benefits to more people than required.
In those states that have opted to provide more than just the mandatory benefits, the program would be considered a “Medicaid expansion.”
All states have this information published on their state government websites, but it can be time-consuming to navigate through all of the information. The resources available on these sites are also often written in medical and legal jargon, adding to the headache.
In the following article, I have compiled all of this information and organized it by state so that you can have a clear picture of all the benefits you are entitled to in your state of residence’s Medicaid program.
Quick Navigation Links
- What are the Minimums Set by the Federal Government?
- States Without Expanded Medicaid
- Elective Benefits, State by State
- How Medicaid Coverage Works
- Final Thoughts and Takeaways
What are the Minimums Set by the Federal Government?
The federal government sets mandated minimums on two parts of Medicaid coverage. First, there are mandatory groups that must be eligible for Medicaid in every state. Secondly, there are mandatory benefits that each state must provide through their Medicaid program.
No matter where you live, if you are currently enrolled in a Medicaid program in any of the 50 states, you will be able to receive the care that the federal government has set as the minimum requirement of all states.
If you are not enrolled but are applying for Medicaid, you will be approved to receive Medicaid if you fall into any of these mandatory groups. The only exceptions are special circumstances, such as current incarceration or illegal residence in the United States.
Who are the Mandatory Groups Included in Medicaid Coverage?
Regardless of state, the following groups of people must be covered in the state’s Medicaid program:
- Low-income pregnant women
- Any children in a low-income family
- Parents or guardians in a low-income family
- Foster children
- Disabled people
- Low-income people 65 and over
What is considered “low-income” will vary based on the federally-set poverty guidelines of the current year and the number of people in the household. The income limit amount is expressed in a percentage between 100-200% of your state’s most recent federal poverty levels.
See the Office of the Assistant Secretary for Planning and Evaluation website for the most up-to-date guidelines, where the latest information is published.
I’m 65+. What if I Already Have Health Coverage Through Medicare?
If you are 65 and over, fall within the income limit in your state, and are enrolled in Medicare already, you are still eligible for Medicaid. This is what is called “dual enrollment”. The Medicaid coverage will expand your benefits to cover things not included in Medicare and cover some or all of your Medicare copays.
There are many benefits to dual enrollment and no penalties for enrolling in both of these government-funded healthcare plans, so be sure to access all healthcare options available to you.
What are the Mandatory Benefits Included in Medicaid Coverage?
All of the United States will have the federal minimums as the base for their Medicaid program. If you are enrolled in Medicaid in any state of the country, you can expect at least the following to be covered by your benefits:
- Preventative screenings and tests
- Office visits with a doctor
- Inpatient hospital stays
- Outpatient hospital visits
- Nursing home care
- Home care
- Laboratory testing
- X-rays and some other imaging services
- Midwife care
- Birthing centers (licensed only)
- Pediatric care
- Transportation for medical reasons
- Tobacco cessation counseling if you are pregnant
If you are in need of any of these services and are enrolled in Medicaid, make an appointment or inquire about enrollment right away since you are entitled to these benefits!
If you are not enrolled but think you may be eligible, there are no set enrollment periods, and you can start the process of applying at any time. If you want some more information about applying for Medicaid in your state, follow the link here to read up on Medicaid eligibility by state.
States Without Expanded Medicaid
Most states have expanded their Medicaid programs to include benefits that expand past the mandatory groups and benefits. States can receive funding in exchange for expanding their Medicaid under the Affordable Care Act.
However, there are currently twelve states that have not expanded their Medicaid program. In these states, enrolling in Medicaid would only entitle you to the above list of mandatory benefits.
The following are the twelve states without expanded Medicaid:
- Alabama
- Florida
- Georgia
- Kansas
- Mississippi
- North Carolina
- South Carolina
- South Dakota
- Tennessee
- Texas
- Wisconsin
- Wyoming
These states will still have Medicare programs. The programs will just have fewer benefits and be open to a smaller population of state residents.
Elective Benefits, State by State
Many states elect to offer benefits outside of the ones listed above, completely or partially. A few examples of elective benefits are visits to specialists, prescription items, vision care, dental care, and some screening services. All of these and others will be covered in some states but not in others.
The rest of the article will outline each state’s elective benefits. To learn all of the benefits offered by Medicaid in your state, be sure to include the above mandatory benefits with all of the benefits listed below by your state of residence.
| Alaska | Dental care Dialysis Family Planning Services Specialized Services: audiology, podiatry, optometry, Hospice Medical equipment, such as prosthetics, glasses, ventilators, etc. Prescription coverage Physical therapy |
| Arizona | Dental care Dialysis Family Planning Services Specialized Services: audiology, podiatry, optometry, Hospice Medical equipment, such as prosthetics, glasses, ventilators, etc. Prescription coverage Physical therapy Behavioral therapies |
| Arkansas | Dental care Family Planning Services Specialized Services: audiology, podiatry, optometry, etc. Chiropractor Hospice Medical equipment, such as prosthetics, glasses, ventilators, etc. Prescription coverage Physical, occupational, and speech therapy Behavioral therapy |
| California | Dental care Personal care Specialized Services: audiology, podiatry, optometry, Hospice Medical equipment, such as prosthetics, glasses, ventilators, etc. Prescription coverage Physical, occupational, and speech therapy Behavioral therapy |
| Colorado | Dental care Family planning Personal Care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment, such as prosthetics, glasses, ventilators, etc. Prescription coverage Physical, occupational, and speech therapy Behavioral therapy Vision care |
| Connecticut | Dental care Family planning Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment, such as prosthetics, glasses, ventilators, etc. Prescription coverage |
| Delaware | Family planning Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment, such as prosthetics, glasses, ventilators, etc. Prescription coverage |
| Hawaii | Dental care Family planning Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment, such as prosthetics, glasses, ventilators, etc. Prescription coverage |
| Idaho | Dental care Family planning Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Weight loss |
| Illinois | Dental care Family planning Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care |
| Indiana | Dental care Family planning Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Chiropractic services |
| Iowa | Dental care Family planning Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Cell phone assistance Vision care |
| Kentucky | Dental care Family planning Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Tobacco cessation Vision care Radiology |
| Louisiana | Dental care Dialysis Family planning Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| Maine | Dental care Chiropractic care Family planning Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Physical therapy Occupational therapy Speech therapy |
| Maryland | Dialysis Diabetes care Family planning Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| Massachusetts | Dental care Dialysis Diabetes care Family planning Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy Out-of-state emergency care |
| Michigan | Dental care Dialysis Diabetes care Chiropractic Family planning Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| Minnesota | Dental care Diabetes care Family planning Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| Missouri | Dental care Dialysis Diabetes prevention Family planning Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Tobacco cessation Physical therapy Occupational therapy Speech therapy |
| Montana | Dental care Dialysis Family planning Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| Nebraska | Dental care Family planning Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| Nevada | Dental care Dialysis Family planning Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy Smoking cessation products |
| New Hampshire | Dental care Dialysis Family planning Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| New Jersey | Dental care Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| New Mexico | Dental care Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Vision care Physical therapy Occupational therapy Speech therapy |
| New York | Dental care Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Vision care Physical therapy Occupational therapy Speech therapy |
| North Dakota | Dental care Dialysis Chiropractic services Family planning Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| Ohio | Dental care Dialysis Chiropractic services Family planning Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| Oklahoma | Dental care Dialysis Family planning Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy Radiation and chemotherapy Tobacco cessation |
| Oregon | Dental care Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| Pennsylvania | Dental care Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| Rhode Island | Dental care Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Vision care Physical therapy Occupational therapy Speech therapy |
| Utah | Dental care Chiropractic services Family planning Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| Vermont | Dental care Dialysis Diabetic supplies Family planning Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, wheelchairs, ventilators, etc. Prescription coverage Mental health services Naturopaths Nutrition therapy Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| Virginia | Dental care Family planning Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Physical therapy Occupational therapy Speech therapy |
| Washington | Dental care Family planning Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Substance abuse treatment Vision care Physical therapy Occupational therapy Speech therapy |
| West Virginia | Chiropractic services Dental care Diabetes prevention Family planning Personal care Specialized Services: audiology, podiatry, optometry, etc. Hospice Medical equipment such as prosthetics, glasses, ventilators, etc. Prescription coverage Mental health services Nutrition counseling Substance abuse treatment Tobacco cessation Vision care Physical therapy Occupational therapy Speech therapy |
What if a Service I Need is Not Listed?
The chart above is a compilation of what each state has stated is covered through Medicaid, at least partially. Often, one state will group services differently, so if you need a treatment but did not see that treatment listed by your state, that does not necessarily mean it won’t be covered.
For example, a few states explicitly assert that diabetic supplies are covered. The ones who do not explicitly say this most likely still cover these supplies, but it is considered an element of prescription or medical equipment.
So, if you have questions about a specific treatment or procedure, it is always best to still call your Medicaid information line. The line will be able to confirm the coverage that is available to you for the service in question.
Medicare in my State Doesn’t Cover a Service I Need. Can I Travel to One That Does?
If you are hoping to be able to travel in order to have a service covered, that is unfortunately not going to work. In order to be covered for treatment in a state, you must be enrolled in that state’s specific Medicaid program. The only way to enroll in a Medicaid program is to be a resident living in that particular state.
So, you can’t live in Texas and have Texas Medicaid and travel to Colorado to have Medicaid pay for dental services.
You could, however, move to a state with the coverage you need and apply for Medicaid there. Each state has a different application process and eligibility requirements. To see an in-depth overview of each state’s Medicaid application process, click here.
How Medicaid Coverage Works
There are three different ways that the above services can be covered: completely, partially, or by cost-sharing. Once again, how a service is covered will depend on your state of residence and your income.
What is Complete Coverage?
If your Medicaid program completely covers a service, that is the best outcome possible. It means that there will be no money coming out of your own pocket, there is not a limit to the amount of treatment you are receiving, and there is not a waiting period between treatments.
An example of a benefit that is completely covered through Medicaid would be dental benefits, excluding orthodontia, in Colorado. Residents of Colorado that are enrolled in Medicaid have comprehensive dental benefits.
What is Partial Coverage?
A benefit can be partially covered in a few different ways. One way is if a treatment is fully covered only once in a set amount of time. An example of a benefit you see a lot of this with is vision care and eyeglass coverage.
Most states that offer vision care only cover an eye exam once every one or two years. Additionally, the coverage usually includes a new set of eyeglasses every two years, as long as there was a significant change in the prescription between visits.
Another way that coverage can be partial is if the Medicaid benefits cover only a limited set of services, such as an annual dental exam with fluoride and x-rays. Any procedures outside of this set would be completely out-of-pocket costs.
Another form of this kind or partial coverage up until a certain financial point. At this point, all expenses beyond that financial point would be out of pocket.
This sort of partial coverage is common with dental, such as in Arkansas, where you can get any needed dental service, but any costs outside of the $500 limit would fall under your financial responsibility.
What is Cost-Shared Coverage?
Cost-shared coverage can happen in one of two ways. There might be copays for a type of service, where you would pay a set amount each visit for as long as you are receiving that service.
However, there are some services that will never have copays. There are no copays for nursing home residents or hospice care, for example.
Prescription drug benefits almost always have copays. Most medications will fall into a category with a very minimal copay, while few will be in categories with more significant copays. The copays for prescription drugs in Medicaid are always under $5, with common generics costing less than a dollar per refill. The largest copay you may have in Medicaid is with certain emergency services.
The other form of cost-sharing is a deductible with your Medicaid benefits. This means that there is some annual set amount that you must pay for out of pocket before Medicaid begins to cover any services at all.
When there is a deductible in Medicaid, it is usually calculated by your income. So, those enrolled in Medicaid may not have a deductible at all if they do not earn more than the poverty line. On the other hand, if you are eligible for Medicaid but are earning more than the federal poverty line, the amount exceeding the poverty line would be used to determine your deductible.
An example of Medicaid with a deductible is Wisconsin’s Medicaid, called BadgerCare. Services outside of preventative are paid for out of pocket until the deductible amount is met. Afterward, coverage might be complete, partial, or have small copays.
What if I Can’t Afford My Copay or Deductible?
Even if you cannot cover the cost of the out-of-pocket expenses, there are still ways for you to receive the care needed.
Inability to Pay in Emergency Situations
If you need emergency treatment but can’t afford the out-of-pocket cost, you should still always go to the emergency room. Hospitals are obligated by law to provide treatment to all patients in an emergency.
Additionally, the hospital is obligated to provide the same level of care to a patient who can’t pay as would be given to a patient who can pay.
Your right to care is codified into United States law. To read the Emergency Medical Treatment & Labor act in its original form, a link to the statute is provided here.
Inability to Pay in Non-Emergency Situations
If you can’t afford the out-of-pocket cost temporarily and do not have debt at the clinic already, you can almost always opt to pay at a later date. The best thing to do is communicate with staff, and they can often defer payment up to 90 days.
However, if your inability to pay is a chronic issue, you may start being denied care that is not an emergency. If this is your situation, I would advise you to look into your Medicaid benefits and see if they need to be reevaluated.
I would also suggest finding out if the hospital you need treatment at has a financial assistance policy. Nonprofit hospitals must have such assistance, and they can often waive or discount some of the debt incurred.
Final Thoughts & Some Takeaways
There is an incredible amount of information and misinformation about Medicaid coverage, likely because of state differences.
This article outlined much of the information you will need to determine if a service you need has complete or a least some coverage. If you still are unsure about something you need, it is always best to contact your state’s department responsible for the Medicaid program.
While Medicaid might not always completely cover the cost, it offers life-changing assistance to a considerable portion of the American population. If you are a part of that population or are planning to enroll, this guide was written so that you can make the best decisions for your and your family’s health.
