Medicaid covers hospital care, doctor visits, and prescription drugs, but it does not cover everything a person might need. Dental work, vision care, hearing aids, and long-term care in a nursing home are often excluded or only partly covered — and what is excluded depends on which state you live in and which Medicaid program you are enrolled in.

Key Takeaways

  • Medicaid does not cover dental care, eyeglasses, or hearing aids in most states, though some states offer limited coverage for children or emergencies.
  • Nursing home care and assisted living are not covered by standard Medicaid; you must spend down your assets to near-zero before Medicaid will pay for long-term care.
  • Cosmetic procedures, weight-loss surgery, and fertility treatments are excluded in all states unless medically necessary for a specific condition.
  • Each state designs its own Medicaid program, so coverage gaps differ — what is not covered in one state may be covered in another.
  • If Medicaid denies a service, you can request a review, but you must do so within the timeframe your state specifies, usually 30 to 60 days.

Services Medicaid Routinely Does Not Cover

Dental care is not covered for adults in most states. Children under 21 may receive dental coverage under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, but this varies by state. Some states cover emergency dental work — such as extraction for infection — but not routine cleanings or fillings. A few states (including New York, California, and Delaware) offer more comprehensive adult dental coverage, but these are exceptions.

Vision care and eyeglasses are not covered for adults in most states. Children under 21 typically receive eye exams and one pair of glasses per year under EPSDT. Adults may be covered for vision care only if it is tied to treatment of a medical condition — for example, an eye exam to monitor diabetic retinopathy. Medicaid does not pay for routine eye exams or replacement glasses for adults in most places.

Hearing aids and hearing tests are not covered in many states. Some states cover hearing aids for children but not adults. A few states (including Connecticut, New Hampshire, and Rhode Island) cover hearing aids for all ages, but coverage limits and the number of devices paid for per year vary widely. Medicaid may cover an audiologist's evaluation if it is part of treatment for an underlying medical condition, but the device itself is often not covered.

Cosmetic procedures are never covered, even if they improve function. This includes rhinoplasty, liposuction, and most reconstructive surgery after injury or illness. The exception is surgery that restores function after a medical event — for example, reconstructive surgery after a mastectomy for breast cancer may be covered, but the decision depends on your state and the specific procedure.

Long-Term Care and Nursing Home Coverage

Medicaid does not cover nursing home care or assisted living as a first step. You must first spend down your own money until your assets fall below your state's limit — usually between $2,000 and $3,000 for an individual. This is called the spend-down requirement. Once you meet the asset limit, Medicaid will begin to pay for nursing home care, but only for skilled nursing facilities, not for assisted living or independent senior housing.

The spend-down process can take months or years depending on how much you have saved. During this time, you pay the nursing home out of pocket. Some people use a Medicaid planning attorney to structure their assets in ways that preserve some money for a spouse or children while still meeting Medicaid's rules, but this must be done before you need care — once you are already in a facility, it is too late.

Home care and personal assistance are covered in some states under Medicaid's home and community-based services waiver, but availability is limited and waiting lists can be years long. Your state decides whether to offer this program and how many people it will serve.

Fertility, Weight Loss, and Elective Procedures

Medicaid does not cover fertility treatments, including in vitro fertilization (IVF), artificial insemination, or fertility drugs in most states. A handful of states (including Arkansas, Illinois, and New Hampshire) cover some fertility services, but coverage is narrow and often requires proof that infertility is due to a medical condition rather than age or other factors.

Weight-loss surgery and weight-loss drugs are not covered unless you have a related medical condition — such as severe obesity that is causing joint damage or sleep apnea — and your doctor documents that the surgery is medically necessary. Even then, coverage is not may provide and depends on your state's rules.

Elective procedures — such as cosmetic dentistry, routine eye surgery for convenience, or non-emergency procedures — are not covered. If a procedure is deemed elective rather than medically necessary, Medicaid will deny it.

Medications and Supplements Not on the Formulary

Medicaid covers prescription drugs, but each state maintains a formulary — a list of drugs it will pay for. If your doctor prescribes a drug that is not on the formulary, Medicaid will not pay for it unless your doctor requests a prior authorization and documents that you have already tried other drugs on the formulary without success.

Over-the-counter medications, vitamins, and supplements are not covered by Medicaid. This includes pain relievers, cold medicine, and multivitamins. If your doctor prescribes a vitamin or supplement as treatment for a specific deficiency, it may be covered, but this is rare and requires documentation.

Some states cover more drugs than others. If a drug is denied, you can ask your doctor to submit a prior authorization request, which usually takes 24 to 72 hours. If the request is denied, you have the right to appeal.

Transportation, Childcare, and Other Support Services

Medicaid does not cover transportation to medical appointments, though some states offer non-emergency medical transportation (NEMT) as part of their program. NEMT is not available in all states and is usually limited to trips to covered medical services. You pay out of pocket for transportation to other appointments.

Childcare, housekeeping, meal preparation, and other support services are not covered by standard Medicaid. Some states offer limited coverage for these services under home and community-based services waivers, but these programs have waiting lists and are not available to everyone.

Mental health and substance use treatment are covered services, but the specific types of treatment covered vary by state. Inpatient psychiatric care is covered, but outpatient counseling, therapy, and rehabilitation programs may have limits on the number of visits or the types of providers covered.

How to Find Out What Your State Covers

Because each state runs its own Medicaid program, what is not covered in one state may be covered in another. To find out what your state does and does not cover, contact your state Medicaid office or visit your state's Medicaid website. You can also call your Medicaid managed care plan if you are enrolled in one — they can tell you what services are covered under your specific plan.

If you receive a notice that Medicaid has denied a service, the notice will explain why and will tell you how to request a review. You usually have 30 to 60 days to file an appeal, depending on your state. You do not need a lawyer to appeal, but you can bring one if you choose.

Your doctor can also help. If Medicaid denies a service your doctor prescribed, ask your doctor to submit a prior authorization request or to write a letter explaining why the service is medically necessary. This does not always change the decision, but it gives your appeal a stronger foundation.

Frequently Asked Questions

Does Medicaid cover glasses or contacts?

Medicaid covers one eye exam and one pair of glasses per year for children under 21 in most states. Adults are not covered for routine vision care in most states, though some states cover eye exams if they are part of treatment for a medical condition like diabetes. Contact lenses are rarely covered.

Will Medicaid pay for my dental work?

Medicaid does not cover dental care for adults in most states. Children under 21 may receive coverage under EPSDT. A few states offer adult dental coverage, and some states cover emergency dental work like extraction for infection. Contact your state Medicaid office to find out what your state covers.

Does Medicaid cover nursing home care?

Medicaid covers nursing home care only after you have spent down your assets to your state's limit, usually $2,000 to $3,000. It does not cover assisted living or independent senior housing. Once you meet the asset limit, Medicaid will pay for skilled nursing facility care.

What happens if Medicaid denies a service my doctor prescribed?

You have the right to request a review, usually within 30 to 60 days of the denial notice. Ask your doctor to submit a prior authorization request or to write a letter explaining medical necessity. You can also file a formal appeal with your state Medicaid office.

Does Medicaid cover fertility treatments?

Medicaid does not cover fertility treatments in most states. A few states (Arkansas, Illinois, New Hampshire) cover some fertility services, but coverage is limited. Check with your state Medicaid office to find out whether your state covers any fertility services.