The availability of Medicaid services depends upon the beneficiary’s age group as well as other classifications. Available Medicaid services also vary among states, as state Medicaid agencies can sometimes make their own decisions about coverage. Here are a few types of services that are often of interest to Medicaid candidates and beneficiaries.
Dental coverage: Under Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, states must provide dental coverage for all children 21 years old or younger who are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). The minimum services that states are required to provide for children include treatment of pain and infections, tooth restoration and dental health maintenance.
States may choose whether to extend dental coverage to adults who are covered by the state’s Medicaid program. While many states offer emergency dental services to adults, less than half of U.S. states currently provide comprehensive dental coverage for adults. Seniors who participate in the Programs for All-Inclusive Care for the Elderly (PACE) program are eligible for dental coverage.
Behavioral Health Services – Medicaid covers many mental health services, including treatment, long-term care and emergency services for those with mental disorders and substance abuse problems. Children covered by Medicaid and CHIP are eligible for screening and treatment of any mental illnesses or conditions.
Immunizations – All children who are 18 years of age or younger and covered by Medicaid or CHIP will receive access to all vaccinations recommended by the Advisory Committee on Immunization Practice (ACIP) through the Vaccines for Children (VFC) program. Some state Medicaid agencies also provide vaccinations for Medicaid and CHIP beneficiaries who are 19 and 20 years old. While the Center for Medicare and Medicaid Services (CMS) does not require states to provide vaccinations for adults, most state agencies will provide certain vaccinations to adults who are covered by Medicaid. However, these vaccinations are generally not as comprehensive as the ACIP standards for children.
Vision and hearing – As part of the EPSDT benefit, children covered by Medicaid and CHIP receive vision and hearing screening and services including diagnosis and treatment of vision and hearing problems. Vision and hearing benefits generally do not extend to other Medicaid beneficiaries, but some pregnant women and people with disabilities may be eligible for some of these benefits. For instance, many states provide some limited coverage of hearing aid products and related services for those who qualify.
Prescription Drug Coverage – While federal law makes pharmacy coverage an optional benefit for state Medicaid agencies to offer, all U.S. states presently extend coverage for outpatient prescription drugs to all eligible Medicaid participants.
Tobacco cessation – Many state Medicaid agencies offer smoking cessation benefits. The federal Medicaid law requires individual U.S. states to cover smoking cessation services for pregnant women.
The following chart demonstrates some of the services covered by Medicaid:
|Dental||Behavioral Health Services||Immunizations||Vision / hearing||Prescription Drug coverage||Tobacco Cessation|
|Children 18 years old or younger||Yes (Provided for all children participating in Medicaid or CHIP)||Yes (including screenings)||All recommended vaccinations provided under VFC program||Yes||Yes||Some limited coverage|
|Adults||Not required, but offered in some states (State Medicaid agency decides)||Yes||Some vaccinations covered by most state Medicaid agencies||Hearing assistance products and services covered by some states||Yes||Some limited coverage|
|Pregnant women||Provided in some states as part of Medicaid benefits for pregnant women||Yes (including screenings for and treatment of maternal depression in some states)||Some vaccinations covered by state Medicaid agencies||Vision and hearing covered by Medicaid for pregnant women in some states||Yes||Yes|
|Elderly||Provided for elderly Medicaid beneficiaries participating in the PACE program||Yes||Some vaccinations covered by most state Medicaid agencies. Some vaccinations provided through Medicare||No||Yes||Some limited coverage|