Medicaid Mandatory Coverages

Every state Medicaid program must cover certain groups of people  and services that are defined by federal law as mandatory.

The groups that include certain categories of people are often called the Categorically Needy (CN).

The mandatory Medicaid coverage groups are primarily:

*Low income families with children that receive cash assistance through the Temporary Assistance for Needy Families (TANF) program or with assets and incomes meeting the requirements of the Aid to Families with Dependent Children (AFDC) program prior to the passage of the TANF welfare reform law

*Persons receiving Supplemental Security Income (SSI) benefits

*Pregnant women and children with family income below a specific level

*Children that receive foster care and adoption assistance under the Social Security Act

*Dual Eligible Medicare beneficiaries also known as Qualified Medicare Beneficiaries (QMBs)

*Special protected groups that include certain working disabled beneficiaries and former recipients of SSI benefits

Federal law mandates specific services that have to be covered by Medicaid.

There are several medical services that Medicaid requires individual states cover. It is important that you understand the services that you are entitled to when you are covered by Medicaid.

Mandatory Medicaid services coverages include:

*Inpatient hospital services

*Outpatient hospital services

*Federal qualified health center services

*Rural health clinic services (if allowed by state law)

*X-ray and laboratory services outside a clinic or hospital

*Nursing facility services for people over the age of 21

*Physician Services

*Certified family nurse and pediatric practioner services

*Nurse mid-wife services

*Surgical and medical services of a dentist

* Early and Periodic Screening, Diagnosis and Treatment (EPSDT) for children

* Family plannning services and supplies

*Home health services for Medicaid beneficiaries who can get nursing services

*Pregnancy services that include pre and postpartum care

If you feel that you qualify for Medicaid coverage you should contact your local Medicaid office to apply for Medicaid. If you are are a beneficiary of Medicaid, you need to know which services you can receive under the Medicaid program.