Mandatory Benefits — What Every State Must Cover

Federal Medicaid law requires all states to cover these services for eligible beneficiaries:

  • Inpatient and outpatient hospital care
  • Physician and licensed practitioner services
  • Laboratory and X-ray services
  • Nursing facility services (for adults 21+)
  • Home health services
  • EPSDT — Early and Periodic Screening, Diagnostic, and Treatment services for children under 21. This is particularly broad: any medically necessary treatment identified in a screening must be provided, even if that treatment is an optional benefit the state doesn't cover for adults.
  • Family planning services and supplies
  • Prenatal and delivery care
  • FQHC and Rural Health Clinic services

EPSDT for children is especially important — it guarantees broader benefits for kids than for adults in most states.

Optional Benefits — What Most States Add

States can add optional benefits and receive federal matching funds. Most states cover: prescription drugs (all states cover, though formularies vary), physical/occupational/speech therapy, personal care services, case management, hospice care, and clinic services. Optional benefits with more variation by state: adult dental, adult vision, podiatry, chiropractic, and long-term services and supports.

Dental Coverage

Adult dental is optional under federal Medicaid law. As of 2026, approximately 34 states cover comprehensive adult dental (preventive, restorative, extractions); several states cover emergency-only dental; a small number offer nothing for adults. Children's dental is covered in all states under EPSDT regardless of adult dental policy — children can receive comprehensive dental care as a medically necessary service.

Vision Coverage

Adult vision is also optional and varies by state. Most states cover at least eye exams for adults; fewer cover eyeglasses or contacts. Children's vision is covered everywhere under EPSDT — exams and corrective lenses are available when medically necessary for children under 21.

Mental Health and Substance Use

Federal mental health parity law requires Medicaid managed care plans to cover mental health and substance use disorder services at parity with medical/surgical services — no more restrictive limitations or prior authorization requirements. Covered services typically include: outpatient therapy, psychiatric evaluation and medication management, intensive outpatient programs, partial hospitalization, inpatient psychiatric care, and medication-assisted treatment (MAT) for opioid use disorder.

Long-Term Care — A Critical Medicaid Feature

One of Medicaid's most important — and least understood — features is long-term care coverage. Medicare covers nursing home care only for up to 100 days after a qualifying hospital stay. Medicaid covers nursing home care indefinitely for eligible individuals, making it the primary payer for long-term care nationally. Medicaid long-term care involves both income and asset tests more complex than regular Medicaid — consult a Medicaid planning attorney before spending down assets to qualify.

Finding Your State's Specific Benefits

Go to medicaid.gov, select your state, and find the state plan or benefit package. Or call your state Medicaid member services line (on the back of your Medicaid card) and ask about a specific service. Your managed care plan's member handbook also lists covered services in detail. Compare with Medicare Parts A B C D to understand combined coverage if you have both programs.