Medicaid Benefits

In 1965, the Social Security Act was amended to create the Medicaid program. President Lyndon Johnson signed the act into law. Designed to provide health care benefits to millions of needy and low-income people, Medicaid benefits were created to provide health-related coverage for children, seniors, and to certain people who are blind or have other disabilities. Unlike the federally funded Medicare program, Medicaid is funded jointly by the federal government and all fifty states, as well as the District of Columbia. While individual states are charged with running their own Medicaid programs, monitoring is done at the federal level by the Center for Medicare and Medicaid Services. This federal program sets the standards for how states manage and finance their Medicaid programs.

Certain health-care related benefits are mandated by the federal government. Although states manage their own programs, federal regulations require that the following Medicaid benefits be offered:

  • Physician services
  • Nurse midwife services
  • Nurse practitioner services
  • Laboratory services
  • X-ray services
  • Both inpatient and outpatient hospital services
  • Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under the age of
  • 19 (this age goes to 21 for children who are living in foster homes)
  • Family planning supplies and services
  • Community and rural health clinic services
  • Nursing facility services (when necessary) for persons age 21 and older

While these services are required, states can obtain federal government approval to elect to provide coverage for additional health care services. These services are referred to as “optional” Medicaid benefits. They vary from state to state, but may include:

  • Prescription drugs
  • Dental care
  • Eye glasses and vision care
  • Mental health services
  • Home health services
  • Case management
  • Rehabilitation services such as physical therapy
  • Hospice care

To ensure that eligible children receive these services; states are required to inform parents about the EPSDT program. States must also provide transportation, and may also assist with scheduling of appointments.

Medicaid benefits are available for millions of Americans. Designed to provide health-related insurance to low-income families and individuals, Medicaid serves a large segment of the population by making free or low-cost health treatment possible. States are not allowed to charge the insured for Medicaid benefits. However, to offset the huge expense incurred by states, they are allowed to require that patients meet a small deductible or pay a minimal co-payment. Participating physicians are forbidden to charge patients anything over and above what Medicare pays. In certain instances, no co-pay may be charged. Emergency medical services and services to pregnant women are exempt from co-payments. Family planning supplies and services are also exempt from these charges. Since states provide varying Medicaid benefit programs, persons applying for, or receiving these Medicaid benefits should understand their state’s eligibility requirements. It is also important to understand the benefits available in each state. Some services may be limited, so it is important for the insured to gather information.

Every state in the union has a Medicaid office. These offices can provide the public with a wealth of information on eligibility and benefits. To help people connect with their state’s Medicaid office, an interactive map may be found on the website of the National Association of State Medicaid Directors.