Medicaid covers doctor visits, hospital care, and prescription drugs, but the exact list depends on which state you live in and which Medicaid program you're in
Medicaid is not one program — it is a partnership between the federal government and each state, so what your state's Medicaid covers can be quite different from what another state's covers. Every state must cover certain basics: doctor visits, hospital stays, emergency care, lab tests, X-rays, and family planning services. Most states also cover prescription drugs, mental health care, and dental care for children. But whether your state covers dental care for adults, vision care, hearing aids, or physical therapy depends on where you live and which Medicaid category you fall into.
The coverage you get also depends on whether you are in traditional Medicaid, a Medicaid managed care plan, or a special program like Medicaid for pregnant people or Medicaid for people over 65. Each has a different set of covered services. Your state Medicaid office or your plan's member handbook will list exactly what is covered under your specific program.
Key Takeaways
- Every state must cover doctor visits, hospital stays, emergency care, lab tests, and family planning, but coverage beyond that varies by state.
- Prescription drug coverage, dental care for adults, vision care, and hearing aids are covered in some states but not others.
- If you are in a Medicaid managed care plan, your plan's member handbook lists what is covered — not the state's full Medicaid list.
- Long-term care (nursing homes and home care) is covered by Medicaid in every state, but may be able to access rules are strict and vary by state.
- You can call your state Medicaid office or your plan directly to ask whether a specific service is covered before you receive it.
Services every state's Medicaid must cover
Federal law requires every state Medicaid program to cover inpatient hospital care, outpatient hospital services, emergency services, physician services (doctor visits), laboratory services, X-ray services, and family planning services and supplies. This means if you go to the emergency room, see a doctor for a checkup, need blood work, or need birth control, Medicaid will pay. These are the floor — the minimum every state must offer.
Medicaid also must cover services for children under 21, which includes well-child visits, immunizations, dental care, vision care, and hearing services. If you have a child on Medicaid, those preventive services are covered in every state.
Services that vary by state
Beyond the federal minimum, each state decides whether to cover prescription drugs, dental care for adults, vision care for adults, hearing aids, physical therapy, occupational therapy, speech therapy, mental health services beyond emergency psychiatric care, and substance use treatment. Some states cover all of these; others cover only a few.
For example, New York's Medicaid covers dental care for adults, but Texas's does not. California covers hearing aids; many other states do not. If you need a service that is not on the federal minimum list, you need to check your specific state's Medicaid program or call your plan to know whether it is covered. Your state Medicaid office website will have a list of covered services, or you can call the number on your Medicaid card.
Long-term care and nursing home coverage
Medicaid is the largest payer for nursing home care in the United States. Every state covers nursing home stays through Medicaid, but the rules for who qualifies are strict. You must have very limited income and assets — the limits vary by state but are usually under $2,000 in countable assets. You also must need a level of care that a nursing home provides, which a doctor must document.
Medicaid also covers home and community-based services in every state, which can include home health aides, adult day care, and other support to help you stay in your home instead of moving to a nursing facility. But the amount of service and the rules for getting it vary widely by state. Some states have long waiting lists for these services.
Prescription drug coverage
Most states cover prescription drugs through Medicaid, but the list of covered drugs (called a formulary) varies by state and by plan. If you are in a Medicaid managed care plan, your plan has its own drug list. Your plan may require you to try a cheaper drug first before covering a more expensive one, or it may require prior approval from the plan before the pharmacy will fill your prescription.
If your state's Medicaid does not cover a drug your doctor prescribed, you can ask your doctor to request an exception, or you can ask the plan to cover it. The process is called a prior authorization request. It can take a few days to a few weeks. If you cannot wait, ask your doctor if there is a covered alternative drug you can use in the meantime.
Mental health and substance use treatment
Medicaid must cover emergency psychiatric services in every state. Most states also cover ongoing mental health care, therapy, and psychiatrist visits through Medicaid, but the amount of coverage and whether you need prior approval varies. Some states limit the number of therapy visits per year; others do not.
Substance use treatment, including medication-assisted treatment (like methadone or buprenorphine) and counseling, is covered by Medicaid in most states. But again, the specifics depend on your state and your plan. If you need mental health or substance use treatment, call your plan or your state Medicaid office to ask what is covered and whether you need prior approval before starting treatment.
What Medicaid does not cover
Medicaid does not cover cosmetic surgery, most weight loss surgery, fertility treatment, or experimental treatments. It does not cover services that are not medically necessary. It also does not cover services from providers who are not enrolled in Medicaid — if a doctor does not accept Medicaid, Medicaid will not pay for a visit to that doctor.
Medicaid does not cover dental care for adults in many states, though it does in some. It does not cover routine vision care or eyeglasses for adults in most states, though it does cover emergency eye care. It does not cover hearing aids in many states. If you need one of these services and your state does not cover it through Medicaid, you may be able to find low-cost options through community health centers or nonprofit organizations.
How to find out what your specific plan covers
The fastest way to know what your Medicaid covers is to look at your member handbook or your plan's website. Your member handbook lists every covered service, any limits on that service, and whether you need prior approval. If you do not have a handbook, call the number on your Medicaid card and ask for one, or ask the person who answers what a specific service costs you.
You can also call your state Medicaid office directly. Every state has a Medicaid customer service line; the number is on your Medicaid card or on your state's Medicaid website. Tell them the service you need, and they can tell you whether it is covered, whether you need prior approval, and what you will have to pay.
Frequently Asked Questions
Does Medicaid cover dental work for adults?
It depends on your state. Some states cover routine dental care, cleanings, and fillings for adults; others cover only emergency dental care; and some cover nothing. Check your member handbook or call your plan to find out what your state covers. If your state does not cover dental care, community health centers often offer low-cost dental services.
Does Medicaid cover glasses or contacts?
Most states do not cover routine vision care or eyeglasses for adults through Medicaid, though they do cover emergency eye care. Children's vision care and glasses are covered in every state. If you need glasses and your state does not cover them, ask your doctor about low-cost options or contact a local nonprofit that provides vision services.
Does Medicaid cover therapy or counseling?
Most states cover mental health therapy and counseling through Medicaid, but the number of visits per year and whether you need prior approval varies by state and plan. Call your plan or your state Medicaid office to ask how many therapy visits are covered and whether your doctor needs to request approval first.
What happens if I need a service that Medicaid does not cover?
You can ask your doctor to request a prior authorization or exception, which means asking the plan to cover it anyway. The plan will review the request and decide. If the plan says no, you can file a complaint with your state Medicaid office. You can also look for the service through community health centers, nonprofits, or government programs that offer low-cost care.
Does Medicaid cover home health care?
Yes, every state covers home health services through Medicaid, including nursing care, physical therapy, and home health aides. But the amount of service you can receive and how long you can receive it varies by state. Some states have waiting lists. Ask your doctor or your plan how much home care is covered and how to request it.