What is Medicaid?
- Establishes its own eligibility standards
- Determines the type, amount, duration, and scope of services
- Sets the rate of payment for services and
- Administers its own Medicaid program
What services are provided with Medicaid?
Of what the Medicaid plans should provide, the States are the final deciders on this issue. In order to receive federal matching funds, there are some mandatory federal requirements that must be met by the States. Required services include:
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- Inpatient hospital services
- Outpatient hospital services
- Rural health clinic services
- Physician services
- Nurse-midwife services
- Pediatric and family nurse practitioner services
- Prenatal care
- Vaccines for children
- Nursing facility services for persons aged 21 or older
- Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21
- Family planning services and supplies
- Home health care for persons eligible for skilled-nursing services
- Laboratory and X-ray services
- Federally qualified health-center (FQHC) services and ambulatory services
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States can still receive Federal matching funds even if they provide optional services. The most common of the 34 approved optional Medicaid services are:
- Diagnostic services
- Clinic services
- Transportation services
- Nursing facility services for children under age 21
- Home and community-based care to certain persons with chronic impairments
- Prescribed drugs and prosthetic devices
- Intermediate care facilities for the mentally retarded (ICFs/MR)
- Optometrist services and eyeglasses
- Rehabilitation and physical therapy services
