Medicaid covers a broad range of health services, from hospital stays and doctor visits to lab work and home health care. The exact list depends on where you live, because the program operates as a partnership between the federal government and individual states. Federal law requires every state to cover a core set of services, but states can add dozens of additional benefits on top of that. The result is that two people on Medicaid in different states may have noticeably different coverage.
Services Every State Must Cover
Federal law sets a floor. No matter which state you live in, your Medicaid plan is required to include inpatient hospital care, outpatient hospital services, physician services, laboratory and X-ray services, and home health services. Nursing facility care for adults 21 and older is also mandatory, as is family planning services and supplies.
These mandatory benefits ensure that the basics are always in place: if you need surgery, diagnostic bloodwork, an imaging scan, or a doctor’s office visit, Medicaid covers it. Home health services mean that if you qualify medically, you can receive nursing visits, home health aide assistance, and medical supplies in your own home rather than a facility.
Optional Benefits That Vary by State
Beyond the federal requirements, states choose from a long menu of optional services. Most states cover many of these, but there is no guarantee. Common optional benefits include:
- Prescription drugs: Nearly all states cover outpatient prescriptions, though formularies and copay rules differ.
- Dental services: Required for children but optional for adults. Some states offer comprehensive adult dental care, others cover only emergency extractions, and a few offer almost nothing.
- Vision care and eyeglasses
- Physical, occupational, and speech therapy
- Prosthetics and dentures
- Hospice care
- Personal care services for help with bathing, dressing, and other daily tasks
- Case management
- Private duty nursing
- Clinic services
States can also cover inpatient psychiatric services for people under 21, residential treatment for people 65 and older in mental health facilities, and respiratory care for individuals who depend on a ventilator. Because the list of allowable optional benefits is so long, checking your specific state’s Medicaid plan is the only way to know exactly what you qualify for.
Children Get the Broadest Coverage
If you’re looking into Medicaid for a child, the coverage picture is significantly wider. Federal law requires states to provide Early and Periodic Screening, Diagnostic, and Treatment services (known as EPSDT) for everyone under 21. This is one of the most generous benefit packages in U.S. health coverage.
Under EPSDT, states must offer regular health screenings at age-appropriate intervals, all recommended immunizations, and vision and dental checkups. The key feature is what happens when a screening finds a problem: the state is required to arrange and pay for any medically necessary treatment to correct or improve that condition, even if the service isn’t normally covered for adults in that state. That means a child on Medicaid can access physical therapy, mental health counseling, orthodontia, hearing aids, or other specialized care that an adult enrollee in the same state might not receive.
Mental Health and Addiction Treatment
Behavioral health coverage has expanded significantly in recent years. Most states now include mental health services and substance use disorder treatment in their Medicaid plans, delivered through a mix of state plan benefits, managed care contracts, and federal waivers.
One important change: coverage of medication-assisted treatment for opioid use disorder is now a permanent, mandatory Medicaid benefit. This means states must cover FDA-approved medications that help people manage opioid addiction, along with the counseling and behavioral therapy that go with them. Many states also cover residential treatment programs, outpatient therapy, crisis intervention, and services through certified community behavioral health clinics. For youth specifically, federal guidance encourages states to cover a full range of substance use and behavioral health services.
Pregnancy and Postpartum Care
Medicaid is the largest single payer for births in the United States, so maternity coverage is a core part of the program. Prenatal visits, labor and delivery, and at least 60 days of postpartum care are covered in every state.
A growing number of states have extended that postpartum window to a full 12 months. As of the most recent federal approvals, 30 states and Washington, D.C. now offer 12 months of coverage after pregnancy, covering an estimated 462,000 additional people. This extension was made possible by the American Rescue Plan and later made permanent by the Consolidated Appropriations Act of 2023. The states that have adopted it span the political spectrum, from California and Massachusetts to Alabama, Georgia, and West Virginia. If your state hasn’t extended postpartum coverage yet, you would lose Medicaid eligibility 60 days after delivery unless you qualify on another basis, such as low income.
Long-Term Care and Home-Based Services
Medicaid is the primary payer for long-term care in the U.S., covering both nursing home stays and home- and community-based services. The two models offer similar types of support, including medical care and personal assistance with daily living tasks like eating, bathing, and dressing. The difference is where and how that care is delivered.
In facility-based care, you live in a nursing home or similar setting where professional staff provide services on-site. In home- and community-based care, you stay in your own home or with a family member, and caregivers visit you there. Some states even allow family members to become certified as paid caregivers. Many states offer home- and community-based services through federal waivers, and there are additional options like the Community First Choice program and self-directed personal assistance services that give enrollees more control over who provides their care and how.
The specific services available to you depend heavily on your state’s Medicaid plan and which waiver programs it operates. Waiting lists for home-based services are common in many states, so facility care is sometimes more immediately accessible even when home care would be preferred.
Preventive Services
For adults who gained Medicaid coverage through the Affordable Care Act’s expansion, preventive services come with no out-of-pocket cost. These include a wide range of recommended screenings for cancer and chronic conditions, routine immunizations recommended by the Advisory Committee on Immunization Practices, sexual health services, and pregnancy-related preventive care. The specific list follows recommendations from the U.S. Preventive Services Task Force and the Health Resources and Services Administration.
In practical terms, this means things like blood pressure checks, cholesterol screening, diabetes screening, certain cancer screenings, and vaccines are available without a copay for expansion enrollees.
Rides to Medical Appointments
A benefit many people don’t know about: Medicaid covers non-emergency medical transportation. If you don’t have a reliable way to get to a doctor’s appointment, lab visit, or pharmacy, your state Medicaid program can arrange a ride. This might be a bus pass, a van service, a rideshare, or mileage reimbursement depending on the state. You typically need to schedule the ride in advance through your Medicaid plan or a transportation broker. Emergency ambulance transport is a separate, standard benefit.
What You’ll Pay Out of Pocket
Medicaid costs to enrollees are minimal compared to private insurance, but they’re not always zero. States have the option to charge small copayments, coinsurance, or premiums. For people with household incomes at or below 150% of the federal poverty level, copays are limited to nominal amounts. For those above that threshold, costs can be somewhat higher, and copays for non-preferred brand-name drugs can reach up to 20% of the drug’s cost.
Certain groups are largely shielded from cost-sharing. Children and pregnant women are exempt from most out-of-pocket charges. Emergency services cannot carry a copay for anyone. States can, however, charge higher copays when someone uses the emergency room for a non-emergency problem, as long as the person’s income is above 150% of the poverty level and certain conditions are met.
Some states charge monthly premiums to specific groups, including pregnant women and infants in families above 150% of the poverty level and certain working individuals with disabilities. But for the majority of Medicaid enrollees, monthly premiums are either nonexistent or very small.