What Does Medicaid Cover?
Medicaid provides some of the most comprehensive health coverage available — often more extensive than private insurance, particularly for long-term care and behavioral health services. Here is a complete breakdown of what Medicaid covers, what is mandatory across all states, and what varies.
Mandatory Benefits (All States)
Federal law requires every state Medicaid program to cover a core set of services for eligible individuals. These mandatory benefits include:
- Inpatient and outpatient hospital services
- Physician and specialist services
- Laboratory and X-ray services
- Nursing facility services for adults 21 and older
- Home health services
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) for children under 21
- Family planning services and supplies
- Federally Qualified Health Center (FQHC) services
- Rural health clinic services
- Nurse midwife and nurse practitioner services
- Tobacco cessation counseling for pregnant women
Optional Benefits (Vary by State)
States may also offer optional benefits beyond the federal minimums. Most states cover many of these, but availability varies:
- Prescription drugs (covered by nearly all states)
- Dental care for adults
- Vision care and eyeglasses for adults
- Physical, occupational, and speech therapy
- Personal care services at home
- Home and community-based waiver services
- Mental health and substance use treatment (beyond mandatory minimums)
- Hospice care
- Prosthetics and orthotics
- Medical transportation
Long-Term Care Coverage
One of Medicaid's most important — and least understood — benefits is long-term care coverage. Medicaid is the primary payer for nursing home care in the United States, covering costs that Medicare does not pay after a short-term stay.
Medicaid also funds home and community-based care through waiver programs, allowing eligible individuals to receive care at home rather than in a facility. This includes personal care assistance, home health aide services, adult day programs, and more.
Mental Health and Substance Use Treatment
Medicaid covers a broad range of mental health and substance use disorder services, including outpatient therapy, psychiatric medication management, inpatient psychiatric care, and substance use treatment programs. The Mental Health Parity and Addiction Equity Act requires Medicaid managed care plans to cover mental health and substance use services at the same level as physical health services.
Children's Coverage (EPSDT)
Children enrolled in Medicaid receive particularly comprehensive coverage through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. EPSDT requires states to provide any medically necessary service to children under 21, even if that service is not covered for adults in the state's Medicaid program. This includes dental, vision, hearing, and developmental screenings.
What Medicaid Does Not Cover
While Medicaid is comprehensive, some services are generally not covered:
- Cosmetic surgery (unless medically necessary)
- Most experimental treatments
- Services not deemed medically necessary
- Care received outside the U.S.
- Some over-the-counter medications (varies by state)
Find Out What Medicaid Covers in Your State
Covered benefits vary by state. Use our free eligibility check to find out which Medicaid programs and benefits may be available to you.
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