Optional Benefits · Other Services by Licensed Professionals (1905 (a) (, 42 CFR 440, 60) · Private Service Nursing Services (1905 (a) (, 42 CFR 440, 80) · Clinical Services. This page describes the mandatory and optional benefits of state Medicaid plans and the corresponding section of the Social Security Act and the applicable coverage regulations under which each benefit is authorized. States are required to provide all mandatory benefits under federal law. States can offer optional benefits if they decide to add them through the state plan process. Medicaid is not required to provide coverage for private nursing services or for care services provided by a household member.
Bandages, adult diapers, and other disposable products are usually not covered, nor are cosmetic surgeries or other elective procedures. Contact your state health care office (Medicaid). Medicaid and the Children's Health Insurance Program (CHIP) provide health care for low-income children and families, as well as long-term services and supports for older people and people with disabilities. Medicaid provides an important source of funding for the U.S. health system.
In the United States, since it covers 19% of all health care expenses and 19% of hospital expenses (figure. In addition to covering services required by federal Medicaid law, all states choose to cover optional benefits, including prescription drugs and home care. Home care, also known as home and community services or HCBS, is long-term care provided in non-institutional settings, such as homes, day care centers, and assisted living facilities. Other long-term care is provided in institutions such as nursing facilities.
Medicaid is the largest payer for long-term care in the United States and covers 61% of total spending. In addition to long-term care, Medicaid offers other benefits that health insurance doesn't usually cover, such as non-emergency medical transportation, which helps enrolled people keep appointments, and comprehensive benefits for children, known as early periodic screening, diagnosis and treatment (EPSDT) services. For example, in some areas, Medicaid doesn't cover dental procedures for adults, but local community clinics often provide services in a staggered manner. Contact the DMH Medicaid eligibility unit if you have a BP beneficiary (ME code 0) who needs cardiopulmonary resuscitation, CSTAR or DD exemption services to help you get MHABD approval.
Medicaid pays Medicare premiums and often provides comprehensive coverage for services not covered by Medicare (such as most long-term care) to nearly 1 in 5 Medicare beneficiaries (13 million). Medicaid accounts for one-fifth of health care spending, more than half of long-term care spending, and a large portion of state budgets. The percentage tends to be higher in the 41 states that expanded Medicaid under the Affordable Care Act (ACA), which includes 21 states that voted for Trump and 20 that voted for Harris. Medicaid may not pay for your transportation, but if you don't, many states offer reimbursement for required trips over a certain distance.
