Medicaid will pay for a variety of services that are medically necessary. Some services are limited to a certain number of units during the fiscal year and other limitations vary among the specific services.
All categorically eligible individuals –either under age 19 or over age 65, blind or disabled according to SSI criteria, or pregnant–are entitled to the following services covered by the Medicaid program. Individuals eligible for Home and Community Based Services are also entitled to these services:
· Hospital Services – Medicaid will pay for inpatient and outpatient hospital services, including inpatient psychiatric services for individuals under age 21 and services for individuals age 65 or older in institutions
· Nursing Home – Medicaid will pay for health services delivered in an inpatient facility that provides 24 hour nursing care, supervision, and services to individuals who are unable to perform their own activities of daily living due to illness or disability
· Pharmaceutical Services - Medicaid will pay for most prescription drugs and some over the counter drugs if the physician writes a prescription for them. Medicaid will pay for no more than three prescriptions per month for each recipient.
· Physician Services - Medicaid will pay for inpatient or outpatient physician services or the services of a certified nurse midwife who is employed by a physician or hospital.
· Dental Services - Medicaid may pay for certain services through the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program for individuals under the age of 21. Medicaid will also pay for emergency dental services for recipients age 21 and over.
· Community Long Term Care (CLTC) - CLTC is a series of services designed to help individuals who might otherwise require nursing home care remain at home, thereby avoiding unnecessary or premature nursing home placement. These services may include, among other things, personal care aide, attendant care, home management, environmental modification, home delivered meals, adult day health care, respite care and personal emergency response system.
· Other Medicaid Services - This covers a variety of services including, among other things, Vision Care, Rural Health Clinic services, Laboratory and X-ray services, and the purchase of Durable Medical Equipment. Other services covered under this category include Ambulance and Medical Transportation, Podiatrist Services, Home Health Services, and certain therapy services.
· Family Planning - This service includes counseling, diagnosis, treatment, and birth control drugs and supplies prescribed or furnished by a physician.
· Hospice Services - This service is available to recipients who have been certified to be terminally ill with a life expectancy of six months or less.
· Supplemental Medical Insurance, Regular - States may enroll certain groups of needy individuals under the Supplemental Medical Insurance program (also referred to as "Medicare Part B") and pay their premiums.
· Supplemental Medical Insurance, Medical Assistance Only (MAO) - States may enroll those individuals who are eligible for Medicare Part B who are not recipients of cash assistance, but who are eligible for Medical Assistance Only (MAO).
Medicaid Program - Mandatory Group Coverage
Medicaid Program - Optional Group Coverage
Medicaid Program - Payments for Services
Medicaid Program - Partners for Healthy Children
Medicaid Program - Overview
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