Medicaid Benefits: What's Covered
Federal law requires states to cover a core set of health services. Many states also cover additional optional benefits. Here's what Medicaid typically includes.
What does Medicaid cover?
Medicaid benefits fall into two broad categories: mandatory benefits that all state programs must cover, and optional benefits that states may choose to cover. Every state Medicaid program must provide at least the mandatory benefits; most also offer many optional services, though the scope varies significantly from one state to the next.
The structure means that Medicaid can look quite different depending on where you live. A benefit that is covered comprehensively in one state may be limited or unavailable in another. The information below describes what is required federally and what is typically offered; for the specifics of your state's program, check with your state Medicaid agency or your state page on this site.
Services all states must cover
All state Medicaid programs must cover the following services under federal law:
- Inpatient hospital services — Medically necessary hospital stays and related care.
- Outpatient hospital services — Services provided at a hospital without an overnight stay.
- Physician services — Visits to doctors and other licensed practitioners for medical care.
- Laboratory and X-ray services — Diagnostic testing and imaging.
- Nursing facility services (adults 21+) — Long-term care in a certified nursing facility when medically necessary.
- Home health services — For individuals entitled to nursing facility care, home health aide and skilled nursing services at home.
- EPSDT (children under 21) — Early and Periodic Screening, Diagnostic, and Treatment — comprehensive preventive and curative care for everyone under 21.
- Family planning services — Counseling and services for family planning, including contraception.
- Rural health clinic services — Services provided at federally certified rural health clinics.
- Federally Qualified Health Center (FQHC) services — Services at community health centers that serve underserved populations.
- Nurse midwife and certified pediatric nurse practitioner services — Obstetric and pediatric services provided by advanced practice nurses.
- Transportation to medical care — Non-emergency medical transportation to and from covered services.
- Tobacco cessation counseling for pregnant women — Counseling and services to help pregnant women stop smoking.
Optional services most states provide
States may choose to cover additional services beyond the federal mandatory minimum. Most states cover many of these optional benefits, though the scope of coverage varies:
- Prescription drugs — Covered by all 50 states, though formularies (covered drug lists) vary.
- Dental services — Comprehensive adult dental is available in some states; emergency-only in others; none in a few. Children's dental is mandatory.
- Vision services — Eye exams and glasses for adults vary by state; vision is covered for children under EPSDT.
- Physical, occupational, and speech therapy — Rehabilitative services — scope varies by state and diagnosis.
- Prosthetics and orthotics — Artificial limbs, braces, and related devices.
- Chiropractic and podiatry services — Available in some states with varying scope.
- Hospice care — End-of-life palliative care for individuals with terminal diagnoses.
- Personal care and home and community-based services — Assistance with daily activities for seniors and people with disabilities, often through HCBS waivers.
- Private duty nursing — Skilled nursing care at home for individuals with complex medical needs.
- Case management — Coordination of services for individuals with chronic conditions or complex needs.
Benefits that vary widely by state
While the mandatory benefit list ensures a baseline of coverage nationwide, some services vary dramatically by state. Adult dental coverage is perhaps the most striking example — some states offer comprehensive dental benefits including preventive care, fillings, root canals, and dentures, while others cover only emergency extractions, and a few states offer no adult dental coverage at all. For a detailed look at dental coverage specifically, see our Medicaid dental coverage guide.
Adult vision coverage follows a similar pattern: comprehensive eye care in some states, limited or no coverage in others. Mental health and substance use disorder services, while increasingly recognized as essential and often required under mental health parity laws, also vary in scope. If a specific benefit is important to your healthcare needs, always verify coverage with your state Medicaid agency before making decisions based on general information.
What your state Medicaid program actually covers depends on your state. Check your state page or contact your state Medicaid agency for specific benefit details.
Children get the most complete coverage under EPSDT
The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program covers everyone under age 21. EPSDT requires states to provide all medically necessary services needed to correct or ameliorate any physical or mental health condition, even if those specific services are not otherwise covered in the state's adult Medicaid plan.
Under EPSDT, children are entitled to regular well-child visits and periodic developmental screenings, immunizations, dental care (including preventive, restorative, and emergency services), vision care including glasses, hearing services and hearing aids, mental health and substance use disorder treatment, and any other medically necessary service. This makes EPSDT significantly more comprehensive than typical adult Medicaid coverage in most states.
Medicaid is the largest payer of long-term care
Medicaid is the largest payer of long-term care services in the United States. This includes nursing facility care, home and community-based services for seniors and people with disabilities who need assistance with daily activities, adult day health services, personal care, and hospice. Long-term care Medicaid has different eligibility rules than standard Medicaid — including asset limits in addition to income limits. For a full explanation, see our seniors & long-term care guide.