Because Medicaid is a state-run program, eligibility varies widely. It’s important to check your state’s guidelines to understand whether you qualify based on your income, household size, and other factors.

Medicaid eligibility can be complex, but understanding both federal and state requirements is key to determining if you qualify. Ready to see what benefits Medicaid provides? Head to the next slide to explore the comprehensive services available through the program.

Medicaid is among the most comprehensive healthcare programs available for low-income individuals and families. The exact benefits can vary depending on the state you live in, but all states must cover certain essential services under federal law. 

Understanding what Medicaid covers is crucial to maximizing the healthcare you or your family can receive through the program.

Regardless of where you live, Medicaid must offer several core health services. These federally mandated benefits include:

• Doctor Visits: Routine checkups and primary care appointments are covered, ensuring you can see a healthcare provider when needed.
• Hospital Stays: Medicaid covers both inpatient and outpatient hospital services, so you’re covered for surgeries, emergency care, and other hospital treatments.
• Laboratory and X-ray Services: Diagnostic tests, like blood work and imaging, are part of the coverage to help detect medical conditions.
• Family Planning Services: Medicaid ensures access to contraceptives, reproductive health services, and pregnancy-related care.
• Nursing Facility Services: For those requiring long-term care in a nursing home, Medicaid provides coverage for medically necessary services.
• Home Health Services: If you need medical care in your home, Medicaid covers home health aides, medical equipment, and therapies.
• Mental Health and Substance Abuse Services: Mental health counseling, psychiatric care, and substance abuse treatment are all covered as part of behavioral health services.

In addition to the federally required services, states can choose to provide additional benefits. Some of these optional benefits include:

• Prescription Drugs: While not required by federal law, almost every state includes prescription drug coverage in their Medicaid benefits. This helps cover the cost of necessary medications.
• Dental Services: Dental care may be offered to both adults and children, although coverage varies significantly from state to state. Some states provide full dental coverage, while others may only cover emergency procedures.
• Vision Services: Eye exams and glasses are often included for children and, in some cases, for adults.
• Physical Therapy and Rehabilitation: States can offer coverage for physical, occupational, and speech therapies to aid recovery from injury or illness.
• Hospice Care: For individuals nearing the end of life, Medicaid may cover hospice services to provide comfort and medical care.

Additionally, Medicaid offers enhanced benefits for certain groups who may require more specialized care:

• Children: Through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, children under 21 receive comprehensive healthcare services, including preventive care, immunizations, and developmental screenings.
• Pregnant Women: Medicaid ensures access to prenatal, delivery, and postpartum care for pregnant women, which helps promote healthy pregnancies and reduce complications.
• Individuals with Disabilities: Medicaid provides additional services for those with disabilities, including long-term care, personal care services, and medical equipment.

One of the major advantages of Medicaid is its ability to reduce out-of-pocket costs. Enrollees generally have low or no copayments for medical services, making it easier to access the care you need without worrying about high medical bills.