You May Qualify for Medicaid – Here’s What It Covers

Medicaid is healthcare coverage designed to help lower-income individuals in the U.S. pay for basic healthcare needs, like hospital and doctor visits, pregnancy care, and blood tests. However, coverage of many health products and services varies by state.

If you want access to healthcare in the United States — whether it’s routine checkups, preventive screenings, or treatment for chronic illnesses — you need health insurance.

The cost can be high, but health insurance can sometimes make these services more affordable. Medicaid is a public health insurance program that people with lower incomes can use to access health services.

Yes. While everyone who’s enrolled in Medicaid is covered for certain services, the details and scope of coverage for many services depend on the state.

If you qualify for Medicaid, your state determines the type, amount, duration, and scope of services within the broad federal Medicaid guidelines.

The best way to find out what you may be covered for is to consult the Medicaid website for your state.

Everyone covered by Medicaid across all 50 states gets access to these services:

Hospital services

• Inpatient hospital services: This includes any care that a patient receives when they stay overnight in a hospital.
• Outpatient hospital services: Includes lab tests like bloodwork, minor surgeries that don’t require overnight hospitalizations, colonoscopies, mammograms, routine physical exams and follow-ups, and imaging services — including MRIs, CT scans, and X-rays.

Doctor and clinic visits

This includes routine exams and follow-up visits with doctors wherever they serve. That includes private offices, rural health clinics, and federally qualified health center services.

Pregnancy services

Pregnancy care includes prenatal visits, labor, and delivery, including midwife services and all medically necessary services directly or indirectly related to the pregnancy.

Pediatric services

Pediatric services include preventive care, screenings, and immunizations for children and teenagers up to 19 years old.

Screening services

These are collectively known as early and periodic screening, diagnostic, and treatment services (EPSDT). They’re part of preventive healthcare and include screenings for common chronic and infectious diseases and cancers.

Transportation for medical care

This includes transport for emergency care — like ambulance service or a medical flight. It also includes transportation for non-emergency care, such as from a ride service. Keep in mind that states differ on when they say rides are necessary.

Outpatient prescription drugs

All 50 states currently provide coverage for outpatient prescription drugs to all categorically eligible individuals and most other enrollees within their state Medicaid programs.

You may be covered for many other healthcare products and services, too.

Here are the types of care that vary by state.

Optional benefits

Optional benefits depend on your state and vary in scope, including:

• prescription drugs
• physical and occupational therapy
• speech
• hearing and language disorder services
• optometry services
• dental services
• chiropractic services
• prosthetics
• private nursing
• hospice care

Physical therapy and other services

All 50 states allow coverage for physical therapy in some form.

But some states have limitations like how many sessions are covered, where the sessions are conducted, whether a referral is needed, and what the copayment costs.

Products and devices

• Eyeglasses: Medicaid covers eyeglasses in all 50 states. However, the states limit how often they can be replaced depending on the age of the patient.
• Hearing aids: Twenty-eight states cover them, but to varying degrees.
  • 12 states cover hearing aids if the patient has “mild” or greater hearing loss, such as difficulty understanding soft speech when there’s a lot of background noise, like in a restaurant.
  • Six require you to have “moderate” or greater hearing loss.
  • Six other states rely on opinions from audiologists and physicians, as there reportedly aren’t any set limits for coverage.
  • Four states don’t have explicit criteria around hearing loss severity.

  Specialist doctor visits

  Here are the specialist doctors Medicaid covers across all states, plus how each may be limited in scope depending on the state:

  • Dental services: Covered by Medicaid in most states, but often limited to routine cleanings and preventive care. Your coverage may also be limited by age — it’s only available for people 21 years and younger in some states.
  • Podiatrist: Accessing podiatrist services in all 50 states using Medicaid usually means you need a referral and prior authorization to demonstrate it’s a medical necessity for you.
  • Optometrist: Provided in all 50 states with a referral and prior authorizations, but there’s a limited scope of care you can access.
  • Psychologist: Provided with a referral and prior authorizations in all 50 states, but the scope of care may be limited.
  • Chiropractor: Of the 24 states that cover chiropractic care under Medicaid, 13 charge beneficiaries a small co-payment up to $3.80 per session for chiropractic treatment. Some also limit the amount of chiropractic care you can get through the program. For example, they may limit the number of visits funded per year, while others place an annual funding cap on chiropractic treatment per enrollee.

  Comprehensive healthcare services for children

  As of December 2022, eight states provide comprehensive state-funded coverage for all income-eligible children regardless of immigration status.

  Rehabilitation services for mental health and substance use disorder

  These services may be covered by Medicaid. However, there are limitations based on the type of service and even where the service is provided. Prior authorization is always required.