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What does Medicaid pay for?

What does Medicaid pay for? The answer will depend on your state, your financial situation, and other factors. Use this guide to see if you qualify.

Medicaid pays for a wide variety of health related services either in part of in full. Everything from preventative care for children under 21 to nursing home care for the elderly is covered by Medicaid, for those eligible. The full range of services vary from state to state, but a set list of services is required by the federal Medicaid program for the state programs to be eligible for federal funds.

What does Medicaid pay for specifically?

Federal guidelines require that Medicaid pay for: Hospital services (inpatient and outpatient), family planning, preventative care for children under 21, nursing home care, home health care, doctor visits, fees for lab work and x-rays, and health clinics and health centers if federally qualified. These federal guidelines are only minimum requirements. Some states offer services above and beyond the minimum such as dental care for adults. Due to economical hardships several of the states that do provide additional services are debating whether or not to discontinue them. The coming years will tell whether these states are able to continue offering additional services.

Does Medicaid pay for the entire amount of my bill?

In some states Medicaid covers the entire amount of the bill for medical services. In other states a co-payment is required by the Medicaid recipient. Federal rules require that co-payments can not be charged to pregnant women or children under 21. A 2004 study by the Kaiser Family foundation showed national Medicaid prescription co-payments of $0.50 – $1.00 for generic and $3 for brand name drugs to be typical. Due to legislation passed by former President George W. Bush called the Deficit Reduction Act (DRA) states may now apply to the federal government for waivers allowing them to change their state Medicaid program, which is of particular concern to those paying co-payments for their Medicaid benefits.



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