Senior's Guide to Medicaid

Senior’s Guide to Medicaid

Medicaid

Medicaid is a financial assistance program designed to provide affordable coverage to low-income children, pregnant women, families, the elderly and the disabled in the United States, including U.S. territories and tribes.

Today, Medicaid is the primary source of health care for low-income Americans. It is run jointly by the federal, state and local governments. The federal government requires some benefits and eligibility requirements be included in all state Medicaid programs. However, specific requirements and benefits can vary from state to state.

Seniors and Medicaid

Low-income seniors comprise a large percentage of Medicaid beneficiaries. Through the program, seniors can receive affordable health coverage. Medicaid differs from Medicare, which is another type of health care available to individuals age 65 or older.

Because Medicaid eligibility includes low-income elderly individuals, some individuals receive both Medicare and Medicaid benefits. These seniors are known as “dual eligible” beneficiaries. Generally, seniors can be dual eligible if they are at least 65 years of age and meet the work requirements for Medicare, while also meeting the income and/or disability requirements for Medicaid.

Individuals with disabilities or end stage renal disease and low household incomes may also qualify for both Medicare and Medicaid.

Learn more about Medicare on the “Medicare” guide.

Medicaid Contact Information Directory

State	Medicaid Program	Department Running Program	Main Phone Number	Office Locator
Alabama	Alabama Medicaid	Department of Public Health	1 (334) 242-5000	https://medicaid.alabama.gov/content/10.0_Contact/10.1_Medicaid_Contacts/10.1.1_Medicaid_Locations.aspx
Alaska	Alaska Medicaid	Department of Health and Social Services	1 (800) 478-7778	https://dhss.alaska.gov/dpa/Pages/contacts.aspx
American Samoa	American Samoa Medicaid	State Medicaid Agency	1 (684) 699-4777	https://medicaid.as.gov/
Arizona	Arizona Health Care Cost Containment System	Department of Economic Security	1 (855) 432-7587	https://www.healthearizonaplus.gov/App/Enrollment_Entity_Search_results.aspx?link=Assistor
Arkansas	Arkansas Medicaid	Department of Human Services	1 (800) 285-1131	https://humanservices.arkansas.gov/contact-us/county-office-map/
California	Medi-Cal	Department of Health Care Services Division	1 (800) 541-5555	https://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx
Colorado	Health First Colorado	Department of Human Services	1 (800) 221-3943	https://www.colorado.gov/cdhs/contact-your-county
Commonwealth of the Northern Mariana Islands	CNMI Medicaid	State Medicaid Agency	(670) 664-4890	https://medicaid.cnmi.mp/
Connecticut	Husky Health	Department of Social Services	1 (800) 859-9889	https://portal.ct.gov/dss/About-the-Department-of-Social-Services/Contact
Delaware	Delaware Medicaid	Division of Medicaid and Medical Assistance	1 (866) 843-7212	https://dhss.delaware.gov/dhss/dmma/locations.html
District of Columbia	DC Medicaid	Department of Health Care Finance	(202) 727-5355	https://dhcf.dc.gov/service/medicaid
Florida	Florida Medicaid	Statewide Medicaid Managed Care	1 (877) 711-3662	https://www.flmedicaidmanagedcare.com/
Georgia	Georgia Medicaid	Division of Family and Children Services	(404) 657-5468	https://dfcs.georgia.gov/locations
Guam	Guam Medicaid	Public Health Social Services	(671) 735-7519	https://dphss.guam.gov/location-2/
Hawaii	Med-Quest	Department of Human Services	Oahu: (808) 524- 3370 Elsewhere: 1 (800) 316-8005	https://medquest.hawaii.gov/en/contact-us.html
Idaho	Idaho Medicaid	Department of Health and Welfare	1 (877) 456-1233	https://healthandwelfare.idaho.gov/offices
Illinois	Illinois Medicaid	Department of Healthcare and Family Services	1 (833) 234-6343	https://www.dhs.state.il.us/page.aspx?module=12&officetype=&county=
Indiana	Indiana Medicaid	Office of Medicaid and Policy Planning	1 (800) 457-4584	https://secure.in.gov/apps/fssa/providersearch/map
Iowa	Iowa Medicaid	Department of Human Services	1 (800) 972-2017	https://hhs.iowa.gov/about/hhs-office-locations
Kansas	KanCare	Department for Children and Families	1 (855) 643-8180	https://www.dcf.ks.gov/services/Pages/DCFOfficeLocatorMap.aspx

Kentucky	Kentucky Medicaid	Department for Medicaid Services	1 (800) 635-2570	https://prd.webapps.chfs.ky.gov/Office_Phone/
Louisiana	Healthy Louisiana	Department of Health	1 (855) 229-6848	https://ldh.la.gov/index.cfm/directory/category/158
Maine	MaineCare	Department of Health and Human Services	1 (800) 977-6740	https://www.maine.gov/dhhs/about/contact/offices
Maryland	Maryland Medicaid	Department of Health and Mental Hygiene	1 (877) 463-3464	https://health.maryland.gov/docs/Contact%20Us%20Information.pdf
Massachusetts	MassHealth	Department of Health and Human Services	(800) 841-2900	https://www.mass.gov/service-details/masshealth-enrollment-centers-mecs
Michigan	Michigan Medicaid	Department of Health and Human Services	1 (800) 642-3195	https ://www.michigan.gov/mdhhs/0,5885,7-339-73970_5461—,00.html
Minnesota	MinnesotaCare	Department of Human Services	(651) 431-2670	https://mn.gov/dhs/people-we-serve/adults/health-care/health-care-programs/contact-us/county-tribal-offices.jsp
Mississippi	Mississippi Medicaid	Division of Medicaid	(800) 421-2408	https://medicaid.ms.gov/about/office-locations/
Missouri	MO HealthNet	Department of Social Services	1 (800) 392-1261	https://dss.mo.gov/offices.htm
Montana	Montana Medicaid	Department of Public Health and Human Services	1 (800) 362-8312	https://dphhs.mt.gov/hcsd/officeofpublicassistance
Nebraska	Nebraska Medicaid	Department of Health and Human Services	1 (855) 632-7633	https://dhhs.ne.gov/Pages/Public-Assistance-Offices.aspx
Nevada	Nevada Medicaid	Department of Health and Human Services	1 (877) 638-3472	Northern Office Locations: https://dwss.nv.gov/Contact/Welfare_District_Offices-North Southern Office Locations: https://dwss.nv.gov/Contact/Welfare_District_Offices-South/
New Hampshire	New Hampshire Medicaid	Department of Health and Human Services	1 (844) 275-3447	https://www.dhhs.nh.gov/about-dhhs/locations-facilities
New Jersey	New Jersey Medicaid	New Jersey Medicaid	1 (800) 701-0710	https://www.nj.gov/humanservices/njsna p /home/cbss.shtml
New Mexico	Centennial Care	Human Services Department	1 (800) 283-4465	https://www.hsd.state.nm.us/lookingforassistance/field_offices_1/
New York	New York Medicaid	Department of Health	1 (800) 541-2831	https://www.health.ny.gov/health_care/medicaid/ldss.htm
North Carolina	North Carolina Medicaid	Division of Health Benefits	(888) 245-0179	https://www.ncdhhs.gov/divisions/social-services/local-dss-directory
North Dakota	North Dakota Medicaid	Department of Human Services	(701) 328-7068	https://www.hhs.nd.gov/human-service/zones
Ohio	Ohio Medicaid	Department of Medicaid	1 (800) 324-8680	https://jfs.ohio.gov/about/local-agencies-directory/local-agencies-directory
Oklahoma	SoonerCare	Human Services	(888) 365-3742	https://oklahoma.gov/okdhs/contact-us/dhsofficelocations.html
Oregon	Oregon Health Plan	Health Authority	(800) 273-0557	https://www.okdhs.org/countyoffices/Pages/default.aspx
Pennsylvania	Medical Assistance	Department of Human Services	1 (866) 550-4355	https://www.dhs.pa.gov/Services/Assistance/Pages/CAO-Contact.aspx
Puerto Rico	Puerto Rico Medicaid	Department of Health and Human Services	(787) 765-2929 Ext. 6700	https://medicaid.pr.gov/Home/DescripcionPrograma/
Rhode Island	RI Medicaid	Executive Office of Health and Human Services	(401) 784-8100	https://dhs.ri.gov/about-us/dhs-offices
South Carolina	Healthy Connections Medicaid	Department of Health and Human Services	(888) 549-0820	https://www.scdhhs.gov/site-page/where-go-help
South Dakota	South Dakota Medicaid	Department of Social Services	1 (800) 597-1603	https://dss.sd.gov/findyourlocaloffice/
Tennessee	TennCare	Department of Human Services	1 (800) 342-3145	https://www.tn.gov/humanservices/for-families/supplemental-nutrition-assistance-program-snap/office-locator-family-assistance.html
Texas	Texas Medicaid	Department of Health and Human Services	1 (800) 335-8957	https://www.dshs.texas.gov/regions/default.shtm
U.S. Virgin Islands	Virgin Islands Medicaid	Department of Human Services	(340) 715-6929	https://www.vimmis.com/Lists/Contact%20Virgin%20Islands%20Medicaid/USVI%20Contact%20Information.aspx
Utah	Utah Medicaid	Department of Health and Human Services	Salt Lake City: (801) 538-6155 Other Locations: 1 (800) 662-9651	https://jobs.utah.gov/jsp/officesearch/#/map
Vermont	Green Mountain Care	Department of Vermont Health Access	1 (800) 250-8427	https://www.healthvermont.gov/local
Virginia	Cover Virginia	Department of Medical Assistance Services	1 (833) 522-5582	https://coverva.dmas.virginia.gov/apply/find-help-in-your-area/
Washington	Apple Health	Health Care Authority	1 (800) 562-3022	https://www.dshs.wa.gov/ALTSA/resources
West Virginia	West Virginia Medicaid	West Virginia Medicaid	1 (800) 318-2596	https://dhhr.wv.gov/pages/field-offices.aspx
Wisconsin	BadgerCare	Department of Health Services	1 (800) 362-3002	https://www.dhs.wisconsin.gov/forwardhealth/imagency/index.htm
Wyoming	Wyoming Medicaid	Wyoming Medicaid	(307) 777-7531	https://health.wyo.gov/contact/

Mandatory Medicaid Benefits

Mandatory benefits are those that are included in all state Medicaid packages. There may be copayments and other costs involved in seeking these benefits. A copayment is a set amount of money that a beneficiary pays to receive medical care, services or treatment. However, any existing copayments and costs are generally low and affordable to beneficiaries.

The mandatory benefits are:

Inpatient hospital visits
Outpatient hospital visits
Nursing facility services
Home health services
Physician services
Rural health clinic services
Early and periodic screening, diagnostic and treatment (EPSDT) services
Federally qualified health center services
Lab and x-ray services
Family planning services
Nurse midwife services
Certified pediatric and family nurse practitioner services
Freestanding birth center services, when licensed or otherwise recognized by the state
Medical transportation services
Tobacco cessation counseling services for pregnant women
Medication assisted treatment (MAT)
Service and item costs for beneficiaries enrolled in qualifying clinical trials

Optional Benefits by Location

Optional benefits are those that may be included in the Medicaid package in your state, depending on your state’s policies. Check your state or territory’s benefits in the following section to determine whether any of the following benefits are included:

Adult day care services
Allergy services
Ambulatory services
Anesthesia
Bariatric surgery
Breast and cervical care services
Case management services
Chiropractic services
Clinic services
Community-first choice options
Dental services
Denture coverage
Dialysis
Durable medical equipment
Eyeglasses coverage
Gastrointestinal services
Gender reassignment care
Genitourinary services
Health homes for individuals with chronic conditions
Hearing services
HIV/AIDS services
Home-delivered meals
Hospice care
Immunizations
Inpatient psychiatric services for individuals under 21 years of age
Interpreter services
Long-term care
Maternity care
Mental health care
Neurology services
Nutritional counseling services
Occupational therapy
Optometry services
Oral and maxillofacial surgery
Orthotics
Other approved services
Other diagnostic, screening, preventative and rehabilitative services
Other practitioner services
Out-of-state care
Peer-recovery services
Personal care
Physical therapy
Podiatry services
Postpartum care
Prenatal care
Prescription drug coverage
Private duty nursing services
Prosthetics coverage
Radiology services

Gender reassignment care
Genitourinary services
Health homes for individuals with chronic conditions
Hearing services
HIV/AIDS services
Home-delivered meals
Hospice care
Immunizations
Inpatient psychiatric services for individuals under 21 years of age
Interpreter services
Long-term care
Maternity care
Mental health care
Neurology services
Nutritional counseling services
Occupational therapy
Optometry services
Oral and maxillofacial surgery
Orthotics
Other approved services
Other diagnostic, screening, preventative and rehabilitative services
Other practitioner services
Out-of-state care
Peer-recovery services
Personal care
Physical therapy
Podiatry services
Postpartum care
Prenatal care
Prescription drug coverage
Private duty nursing services
Prosthetics coverage
Radiology services
Reconstructive surgery
Rehabilitative services
Respiratory care services
School-based services
Self-directed personal assistance services
Services for individuals 65 years of age or older in institutions for mental diseases
Services in intermediate care facilities for individuals with intellectual disabilities
Skin services
Speech, hearing and language disorder services
State plan home and community-based services
Transplant care
Tuberculosis-related services
Urgent care
Vision care

Note:

The list does not include federal mandatory benefits, which are available in all states.

Select your state in the following dropdown menu to check available benefits:

Alabama

Dental services for individuals under 21 years of age who qualify for full Medicaid coverage
Eye care services
Preventative health and education services
Hearing services for individuals under 21 years of age
Home health services
Hospice services
Psychiatric hospital services for children under 21 and adults over 65
Prenatal and postpartum maternity services
Mental health services
Nursing home care services
Out-of-state services
Prescription drugs
Renal dialysis services
Transplant services
Home and community-based care services

Alaska

Behavioral health services
Inpatient psychiatric hospital services for individuals under 21 and over 65
Residential psychiatric treatment services for individuals under 21 years of age
Chiropractic services for children
Community first choice services
Dental services
Dialysis for end stage renal disease
Hearing services
Home and community-based waiver services
Home health services
Hospice services
Long-term care services
Durable medical equipment and supplies
Nutrition services for individuals under 21 years of age
Personal care services
Prescription drugs
Podiatry services
Prenatal and postpartum medical services
Private duty nursing services
School-based services, including hearing, speech-language, physical, occupational and behavioral therapy
Physical therapy services
Occupational therapy services
Speech-language therapy services

Arizona

Immunizations
Prescription drugs
Specialist care
Podiatry services
Behavioral health services
Dialysis
Vision Services for individuals under 21
Dental Services for individuals under 21
Hearing Services for individuals under 21

Arkansas

Adult Behavioral Health Services for Community Independence (ABHSCI)
Hearing services for individuals under 21
Dental services for individuals under 21
Chiropractic services
Durable medical equipment
End-stage renal disease services
Hospice services
Inpatient psychiatric services for individuals under 21
Intermediate care facility services for individuals with intellectual disabilities
Medical supplies
Nursing facility services
Occupational therapy services for individuals under 21
Physical therapy services for individuals under 21
Speech-language therapy services for individuals under 21
Personal care services
Podiatrist services
Prescription drug coverage
Private duty nursing services
Prosthetic devices
Rehabilitative services
Respiratory care services for individuals under 21
School-based mental health services for individuals under 21
Targeted case management services
Ventilator equipment
Vision services

California

Podiatry services
Chiropractic services
Allergy care
Treatment therapies (chemotherapy, radiation therapy, etc.)
Dialysis
Outpatient mental health services (including specialty)
Substance use disorder services
Inpatient specialty mental health services
Prescription drug services
Physical and occupational therapy services
Speech therapy / audiology
Durable medical equipment services
Medical supplies, equipment and appliances
Hearing aids
Dental services
Vision services
Personal care services and other long-term services and supports
Prenatal, delivery and postpartum care
Preventive services and vaccines
Behavioral health treatment for individuals under 21

Colorado

Vision services
Dental services
Hospice services
Private nursing services
Mental and behavioral health services
Inpatient mental health services
Outpatient mental health services
Prescription drug services
Durable medical equipment services
Physical and occupational therapy services
Speech therapy services
Transplant services
Immunizations
Hearing services
Podiatry services
Breast reconstruction surgery
Radiation therapy and chemotherapy services
Pregnancy services, including coverage for newborns up to age one

Connecticut

Preventive care
Women’s health care
Maternity care
Long-term services and supports
Physical and occupational therapy services
Speech therapy services
Hearing services (audiology and hearing aids)
Physical rehabilitation
Dialysis
Vision services
Durable medical equipment (DME) services
Orthotic and prosthetic devices
Hospice services
Dental services
Behavioral health services
Prescription drug services

Delaware

Drug and alcohol abuse services
Speech therapy services
Hearing services
Immunizations
Physical therapy services
Eye exams
Prescription drug services
Assistive technology
Mental health services
Case management and coordination
Hospice services
Dental services

District of Columbia

Eye care
Ambulatory surgical center
Dental services and related treatment
Dialysis services
Durable medical equipment
Hospice services
Medical supplies
Mental health services
Home and Community Based Services (HCBS)
Transplants

Florida

Allergy services
Ambulatory surgical centers
Anesthesia
Assistive care
Behavioral analysis
Cardiovascular services
Chiropractic services
Community behavioral health services
County Health Department (CHD) Services
Dental
Dialysis
Durable medical equipment (DME) and supplies
Gastrointestinal services
Genitourinary services
Hearing services
Hospice services
Integumentary Services
Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) services
Medical Foster Care (MFC) services
Neurology
Oral and maxillofacial surgery
Orthopedic services
Pain management
Podiatry
Prescription drugs
Prescribed Pediatric Extended Care (PPEC) services
Reproductive services
Respiratory services
School-based services programs
Specialized therapeutic foster care
Targeted case management – mental health
Therapy (Occupational, physical, respiratory, speech-language)
Transplant services
Vision services

Georgia

Prescription drugs
Preventive dental care for children
Certain emergency dental care procedures for adults
Medical equipment and supplies prescribed by a doctor and used in the home
Exams and immunizations for children
Hospice care
Vision services for children (limited service for adults)
Hearing services for children
Mental health clinic services
Case management
Mental Retardation Waiver Program
Community Care Services Program
Independent Care Waiver Program
Orthotics and prosthetics
Podiatry services
Speech, physical and occupational therapy
Psychological services for individuals under 21
Dialysis and services for end-stage renal disease
Durable medical equipment

Hawaii

Behavioral health services
Community care services
Dental care
Dialysis
Durable medical equipment (DME)
Habilitation services
Hospice services
Intellectual and developmental disease (I/DD) services
Immunizations
Long-Term Services and Supports (LTSS)
Organ and tissue transplant services
Pregnancy-related services
Prescription drugs
Rehabilitation services
Termination of pregnancy services

Idaho

Mental health counseling and services
Dental services
Durable medical equipment (DME) and medical supplies
Hospice care
Immunizations
Pregnancy services
Prescription drugs
Prosthetics and orthotics
Smoking cessation
Substance abuse treatment services
Vision services
Weight loss services

Illinois

Dental services
Maternity care
Surgery
Prescription drugs
Mental health treatment
Substance abuse treatment
Medical supplies and equipment
Physical, speech and occupational therapy
Eyeglasses and optometrist services
Hearing services
Podiatry services
Chiropractic services
Intermediate care for people who are developmentally disabled
Dialysis services
Hospice care
Respiratory equipment

Indiana

Prescription and over-the-counter drugs
Mental health care
Substance abuse services
Medical supplies and equipment
Dental care
Vision care
Physical, occupational and speech therapy
Hospice care
Podiatry
Chiropractic care

Iowa

Prescription drugs
Women’s health services
Substance abuse services
Mental health care
Dental care
Preventive health services

Kansas

Vaccines
Behavioral health services
Prescription drugs
Eye care visits
Dental care for children (some preventive procedures for adults)
Heart and lung transplants
Weight loss surgery

Enrollees will have additional benefits based on the health plan they choose: https://www.kancare.ks.gov/docs/default-source/consumers/choosing-a-plan/2020-english-vab_final.pdf?sfvrsn=bdf54f1b_8

Kentucky

Intermediate care facilities for people with intellectual disabilities
Behavioral health and substance abuse services
Prenatal care
Breast and cervical cancer treatment
Dental services
Vision services
Prescription drugs

Specific information about covered services can be found by contacting one of the managed care organizations (MCOs) that provide Medicaid in Kentucky. Contact information can be found below:

Aetna Better Health of KY – (855) 300-5528
Anthem Blue Cross Blue Shield – (855) 690-7784
Humana Health Plan – (800) 444-9137
Passport Health Plan – (800) 578-0603
Wellcare of Kentucky – (877) 389-9457

Louisiana

Behavioral health services
Chemotherapy
Chiropractic care
Dental and orthodontic care
Durable medical equipment (DME)
Audiology and hearing aids
Hemodialysis services
Hospice care
Immunizations
Long-term personal care services
Occupational, physical and speech therapy
Pediatric Day Health Care (PDHC)
Program for All Inclusive Care for the Elderly (PACE)
Prescription drugs
Podiatry services
Prenatal care
Psychiatric care
Rehabilitation services
STD clinics
Vision care

Maine

Some of Maine’s covered services require prior authorization. Your doctor will get approval from the MaineCare program.

Preventive services (immunizations, pap smears, mammograms, prostate exams, eye exams)
Behavioral and mental health services
Chiropractic services
Substance use disorder treatment
Durable medical equipment (DME) and supplies
Prescriptions
Hearing aids and hearing services
Eye care and vision services
Podiatry
Rehabilitative services
Dental services
Dialysis
Hospice services
Intermediate care facility for people with intellectual disabilities
Occupational, physical and speech therapy

Covered services depend on the member’s specific benefit package. For more benefit information, call MaineCare Member Services at 1 (800) 977-6740 or 711 (TTY).

Maryland

Ambulatory surgical services
Dental services for beneficiaries under 21 years of age
Eyeglasses for beneficiaries under 21 years of age
Hearing aids for beneficiaries under 21 years of age
Hospice care
Dialysis services
Medical day care services
Medical equipment and supplies
Mental health services
Oxygen and other respiratory services
Personal care services
Pregnancy care
Prescription drugs
Physical therapy
Podiatry services
School-based medical care for children
Statewide Evaluation and Planning Services (STEPS) through local health departments
Substance abuse treatment services
Targeted case management for HIV-infected beneficiaries and other populations
Vision care

Massachusetts

Therapies
Dental services
Prescription drugs
Vision care and eye glasses
Hearing aids
Medical equipment and supplies
Adult day health and foster care
Mental health and addiction services
Long-term care services and supports at home or in a facility
Smoking cessation services

Michigan

Chiropractic care
Dental care
Hearing and speech services
Hospice care
Medical supplies
Prescription drugs
Mental health services
Personal care services
Physical and occupational therapy
Podiatry
Pregnancy and postpartum care
Immunizations
Substance abuse treatment
Surgery
Vision care

Minnesota

Alcohol and drug treatment
Chiropractic care
Dental care
Eyeglasses
Hearing aids
Hospice care
Immunizations
Interpreter services
Medical equipment and supplies
Mental health care
Intermediate care facilities for people with developmental disabilities
Prescriptions and medication therapy management
Rehabilitative therapy
Urgent care

Mississippi

Chiropractic care
Community homes and immediate care facilities for people with intellectual disabilities
Dental care, oral surgery and orthodontics
Dialysis services
Durable medical equipment (DME) and medical supplies
Vision and eyeglasses
Hearing aids and services
Hospice services
Long-term care
Occupational, physical and speech therapy
Organ transplants
Podiatry services
Prescription drugs
Psychiatric care and mental health services
School-based services
Vaccines

Missouri

Ambulatory surgery
Audiology services and hearing aids
Case management for pregnant women
Community psychiatric rehabilitation services
Comprehensive substance treatment and rehabilitation (C-STAR)
Dental services
Durable medical equipment (DME) and some prosthetic / orthotic devices
Hospice care
Personal care and adult day health care services
Podiatry services
Prescription drugs
Rehabilitative services
Transplant services
Vision services and eyeglasses

Montana

Dental care
Audiology and hearing aids
Maternity and newborn care
Mental health services
Nurse First advice line
Prescription drugs
Rehabilitative services
School-based health services
Speech therapy
Substance abuse services
Vision services

Nebraska

Chiropractic services
Dental care
Durable medical equipment (DME), orthotics, prosthetics and medical supplies
Hearing aids
Hospice care
Intermediate Care Facilities for Persons with Intellectual Disabilities (ICF/DD)
Mental health and substance abuse services for individuals 20 years of age or younger
Occupational, speech, physical and audiological therapy
Personal assistance services
Podiatry
Prescription drugs
Private-duty nursing
Program of All-Inclusive Care for the Elderly (PACE)
Mammograms
Medically necessary psychiatric and substance abuse services for adults
Vision care

Nevada

Dental care
Durable medical equipment (DME)
Eye exams and glasses
Hearing tests
Hospice care
Immunizations
Maternity care
Mental health services
Occupational and physical therapy
Orthotics and prosthetics
Over-the-counter drugs with a prescription
Personal care services
Private duty nursing
Prescription drugs
Smoking cessation products
Specialist visits
Speech and hearing services
Substance abuse services

New Hampshire

Adult medical day care
Dental care
Durable medical equipment (DME) and medical supplies
Extended services for pregnant women
Hearing services
Hospice services
Interpreter services
Newborn home visits
Personal care attendant services
Physical, occupational and speech therapy
Podiatry
Prescription drugs
Private duty nursing
Psychotherapy
Vision care

New Jersey

Chiropractic services
Dental care
Durable medical equipment (DME)
Hearing aid services
Hospice care
Inpatient psychiatric care for individuals under 21 and over 65
Intermediate care facilities for people with intellectual disabilities
Licensed practitioner services
Personal care services
Physical, occupational and speech therapy
Podiatry
Prescription drugs
Private duty nursing
Prosthetics and orthotics
Psychological care
Treatment in residential treatment centers
Vision care

New Mexico

Preventive services
Behavioral health care
Long-term care
Specialist services

Specific benefits may vary depending on the plan beneficiaries choose. Applicants are able to choose among four Medicaid plans: BlueCross BlueShield, Presbyterian, Western Sky or FFS.

New York

Dental care
Medical supplies and equipment
Mental health services
Preventive services
Personal care services
Prenatal care
Prescription drugs
Smoking cessation agent

North Carolina

Ambulatory surgical centers
Dental and orthodontia services for children
Hearing services
Medical equipment
Mental and behavioral health care
Orthotics and prosthetics
Prescription drugs
Podiatry
Personal care services
Specialized therapy
Vision services

North Dakota

Chiropractic care
Dental care
Durable medical equipment (DME) and supplies
Hospice care
Mental health care
Prescription drugs
Podiatry
Speech, physical and occupational therapy
Sterilization
Vision care

Ohio

Alcohol and drug addiction services
Ambulatory surgical centers
Audiology services
Chiropractic services
Dental care
Medical equipment
Mental health care
Physical, speech and occupational therapy
Podiatry
Pregnancy care
Prescription drugs
Preventive health services
Private duty nursing
Vision care

Oklahoma

Ambulatory surgical centers
Behavioral health care
Case management services
Chemotherapy and radiation therapy
Dental care
Dentures for adults residing in nursing facilities
Dialysis
Durable medical equipment (DME) and supplies
Hemophilia care
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
Maternity care
Mental health and substance abuse services
Nutritional Services
Pregnancy services
Personal care services
Podiatry services
Prescription drugs and insulin
Transplants
Tuberculosis services
Ultrasound benefits

Additional services for children include the following:

Hearing aids
Immunizations
Incontinence supplies for certain children
Optometric or optical services, including eyeglasses
Orthodontics
Physical and occupational therapy
Private duty nursing
Speech, hearing and language disorder services
Other medically necessary services

Oregon

Chemical dependency care
Dental care
Hearing aids and exams
Hospice care
Immunizations and vaccinations
Labor, delivery and postpartum maternity care
Medical equipment and supplies
Mental health care services
Physical, occupational and speech therapy
Prescription drugs
Private duty nursing
Vision care

Pennsylvania

Behavioral health services
Chiropractic services
Dental and orthodontic care
Dialysis
Durable medical equipment (DME)
Medical Supplies
Hospice care
Maternity care

Podiatry services
Prescription drugs
Prosthetics and orthotics
Specialist care
Substance abuse services
Tobacco cessation services
Vision care

Rhode Island

Dental care
Durable medical equipment (DME)
HIV/AIDS services
Home stabilization services
Hospice care
Interpreter services
Long-term care
Peer recovery support services
Podiatry
Prescription drugs
Rehabilitative services
Vision care

South Carolina

Adult day care services
Ambulatory surgical center
Audiology services
Behavioral health services
Chiropractic services
Durable medical equipment
Eyeglasses
Hospice care
Incontinence supplies
Nutritional supplement services
Occupational, physical and speech therapy
Prescription drugs
Private duty nursing
Psychiatric care
Rehabilitative therapy services
School based rehabilitative therapy

South Dakota

Chiropractic care
Dental care
Diabetes education
Dietician and nutritionist services
Durable medical equipment (DME) and medical supplies
Hospice care
Immunizations
Mental health care
Personal care services
Physical, speech, occupational and audiology therapy
Podiatry
Pregnancy coverage
Psychiatry / psychology
Prescription drugs
School district services
Substance abuse services
Vision care

Tennessee

Chiropractic services for people under 21 years of age
Dental services for people under 21 years of age
Dialysis
Durable medical equipment (DME) and medical supplies
Hospice care
Mental health services
Occupational, physical and speech therapy
Organ transplants
Prescription drugs
Private duty nursing
Psychiatric inpatient, residential and rehabilitative services
Reconstructive breast surgery
Substance abuse services
Vision care
Weight loss surgery

Texas

STAR – Medicaid for children, pregnant women and families

Hearing services
Mental health care services
Prescription drugs and vaccines
Specialist services
Vision care

STAR Plus – Medicaid for individuals with disabilities or older than 65 years of age

Adaptive aids
Adult foster care services
Assisted living
Home meal delivery
Long-term care
Medical supplies
Minor home safety modifications
Occupational, physical and speech therapy
Personal care services
Respite care
Transitional assistance services

Utah

Case management
Chiropractic care
Dental care
Hospice care
Individual and group therapy
Maternity and midwife services
Medical supplies
Mental health medication management
Mental health evaluations
Mental health services
Personal care services
Physical and occupational therapy
Podiatry
Prescription and over-the-counter drugs
Psycho-educational services
Psychosocial rehabilitative services
Psychological testing
Respite care
Specialist care
Speech and hearing assistance
Substance abuse services
Tobacco cessation services
Vision care

Vermont

Chiropractic care
Community mental health centers
Dental care
Diabetic supplies
Eye exams
Gynecological services
Hearing aids
Hospice care
Immunizations
Medical equipment and supplies
Maxillofacial surgery
Mental health counseling
Naturopaths
Nutrition therapy
Occupational, physical and speech / language therapy
Organ transplants
Podiatry
Prescription and over-the-counter drugs
Prosthetics
Psychiatric and psychological care
Respiratory therapy
Specialist services
Substance abuse treatment

Virginia

Addiction and Recovery Treatment Services (ARTS)
Behavioral health services
Dental care
Dialysis for end-stage renal disease
Durable medical equipment (DME) and supplies
Eye examinations
Eyeglasses for members younger than 21 years of age
Glucose test strips
Long-term services and support
Organ transplants
Personal care
Physical, occupational and speech therapy
Podiatry
Program of All-Inclusive Care for the Elderly (PACE)
Prescription drugs
Prosthetic devices
Psychiatric or psychological care
School health services
Substance abuse treatment

Washington

Alcohol and addiction services
Dental care
Interpreter services
Maternity and newborn care
Mental health services
Prescription drugs
Vision care

West Virginia

Cardiac rehabilitation
Chiropractic care
Diabetes education
Durable medical equipment (DME)
Hospice care
Maternity care
Nutritional counseling
Orthotics and prosthetics
Personal care services
Physical, occupational and speech therapy
Podiatry
Prescription drugs
Psychiatric care
Pulmonary rehabilitation
Speciality care
Tobacco cessation

Wisconsin

Case management services
Chiropractic services
Dental services
Eye care, eyeglasses and exams
Hospice care
Intermediate care facility (ICF) services
Medical supplies and equipment
Mental health care services
Psychosocial rehabilitative services
Personal care services
Physical and occupational therapy
Podiatry services
Prenatal care coordination for women with high-risk pregnancies
Prescription and over-the-counter drugs
Respiratory care services for ventilator-dependent members
Speech, hearing, and language disorder services
Substance abuse services
Tuberculosis (TB) services

Wyoming

Information about covered services is not readily available. To learn about services offered through all plans, call the Fiscal Agent at (800) 251-1269.

U.S. Territories:

American Samoa

Comprehensive information about covered services is not readily available. To learn about all services offered, contact the Medicaid Agency by phone at (684) 699-4777 or by email at omr@medicaid.as.gov.

American Samoa is exempt from covering mandatory benefits. It provides 10 of the 17 mandatory benefits. Examples of mandatory programs it does not offer include:

Nursing facility services
Nurse midwife services
Freestanding birth center services

Optional benefits offered by American Samoa Medicaid include dental care, psychologist services and prescription drugs. It also provides federally qualified health center (FQHC) benefits and early and periodic screening, diagnostic and treatment (EPSDT) services for any members younger than 21 years of age.

Chiropractic services
Dental services including dentures
Eyeglasses
Home health services
Hospice services
Inpatient hospital and nursing facility services for individuals age 65 or older in institutions for mental diseases
Intermediate care facility services for individuals with intellectual disabilities
Occupational, physical and speech therapy
Optometry services
Personal care services
Primary care case management services
Private duty nursing services
Prosthetic devices
Respiratory care for ventilator dependent individuals
Services furnished in a religious non-medical health care institution

Guam

Guam provides all mandatory benefits. Optional benefits in Guam include:

Dental care
Prescription drug coverage
Chiropractic services
Dental services including dentures
Eyeglasses
Home health services
Hospice services
Inpatient hospital and nursing facility services for individuals age 65 or older in institutions for mental diseases
Intermediate care facility services for individuals with intellectual disabilities
Occupational, physical and speech therapy
Optometry services
Personal care services
Primary care case management services
Private duty nursing services
Prosthetic devices
Respiratory care for ventilator dependent individuals
Services furnished in a religious nonmedical health care institution

Commonwealth of Northern Mariana Islands

The Commonwealth of Northern Mariana Islands Medicaid program covers all mandatory benefits except freestanding birth center services. It also offers the following benefits:

Clinic services
Dental care and dentures
Chiropractic services
Dental services including dentures
Eyeglasses
Home health services
Hospice services
Inpatient hospital and nursing facility services for individuals age 65 or older in institutions for mental diseases
Intermediate care facility services for individuals with intellectual disabilities
Occupational, physical and speech therapy
Optometry services
Personal care services
Prescription drugs
Medical supplies
Physical and occupational therapy
Prosthetics
Rehabilitative Services
Speech, Hearing and Language Disorders
Services furnished in a religious non-medical health care institution
Targeted case management services
Tuberculosis-related services

Puerto Rico

Puerto Rico is exempt from covering mandatory benefits. It provides 10 of the 17 mandatory benefits. Examples of mandatory programs it does not offer include:

Nursing facility services
Non-emergency medical transportation
Emergency medical services for non-citizens

Optional benefits offered by Puerto Rico Medicaid include:

Chiropractic services
Dental services including dentures
Eyeglasses and optometry services
Home health services
Hospice services
Inpatient hospital and nursing facility services for individuals age 65 or older in institutions for mental diseases
Intermediate care facility services for individuals with intellectual disabilities
Occupational, physical and speech therapy
Optometry services
Personal care services
Prescription drugs
Primary care case management services
Private duty nursing services
Prosthetic devices
Respiratory care for ventilator dependent individuals
Services furnished in a religious non-medical health care institution

U.S. Virgin Islands

Comprehensive information about covered services is not readily available. To learn about all services offered, contact the Department of Human Services (DHS) at the following phone numbers:

St. Thomas: (340) 774-0930
St. Croix: (340) 718-2980
St. John: (340) 776-6334

The U.S. Virgin Islands does not cover two of the mandatory benefits: rural health clinics and freestanding birth centers. Optional benefits include dental services and prescription drugs.

General Medicaid Eligibility for Seniors

Eligibility for Medicaid varies between states. To qualify, seniors must meet criteria based on the following factors:

Income
- An applicant’s annual income must fall within a percentage of the Federal Poverty Level, or FPL. This is a measure of income that is determined each year by the Department of Health and Human Services (DHHS).
Family size
- The total number of people living in the applicant’s home.
Citizenship

Most states require Medicaid beneficiaries to earn somewhere below 138 percent of the FPL to qualify for Medicaid. The 2024 FPL chart for the 48 contiguous states and Washington, D.C. is as follows:

Family Size	Annual Income Limit
1	$15,060
2	$20,440
3	$25,820
4	$31,200
5	$36,580
6	$41,960
7	$47,340
8	$52,720
For families/households with more than 8 persons, add $5,380 for each additional person.

The 2024 FPL chart for Alaska is as follows:

Family Size	Annual Income Limit
1	$18,810
2	$25,540
3	$32,270
4	$39,000
5	$45,730
6	$52,460
7	$59,190
8	$65,920
For families/households with more than 8 persons, add $6,730 for each additional person.

The 2024 FPL chart for Hawaii is as follows:

Family Size	Annual Income Limit
1	$17,310
2	$23,500
3	$29,690
4	$35,880
5	$42,070
6	$48,260
7	$54,450
8	$60,640
For families/households with more than 8 persons, add $6,190 for each additional person.

Income limits generally are based on Modified Adjusted Gross Income (MAGI). MAGI includes adjusted gross income, plus untaxed foreign income, non-taxable Social Security benefits and tax-exempt interest. It does not include Supplemental Security Income (SSI).

However, seniors who receive Supplemental Security Income (SSI) benefits will not have their incomes calculated based on MAGI. Instead, their incomes will be considered using SSI calculations. This means that more of their income is not counted toward the limit, lowering their total income and providing a higher chance of qualifying for Medicaid.

In addition, states have citizenship requirements. To be eligible for Medicaid, seniors should be a U.S. citizen or legal non-citizen, and be able to supply a Social Security Number (SSN) or an application for an SSN.

Information and Documents Needed to Apply

doctor discussing information with senior woman

The Medicaid application process varies from state to state. However, there are a few general steps that are common across the board.

To apply for Medicaid, you will need to provide various types of information along with documents to verify the information you submit.

You may need to provide the following information for yourself and all other members of your household:

Your name
Your contact information
Your address
Your Social Security Number (SSN)
The health insurance coverage you seek

Your residency status
Your citizenship status
Your employment status
Your household income
Your household finances
Your household property

Your health insurance status
Your tribal status
Your veteran status
Your current medical needs
Your current expenses
Your current benefits

Additionally, you may be asked to provide any of the following documents:

The Social Security Number (SSN) or document number of all members of your household
All employer and income documentation for all members of your household (including W-2s, 1099s and other wage and tax statements)
Bank statements

Your state’s Medicaid application form will explain the exact information and documents required to apply.

How to Apply for Medicaid

In order to receive Medicaid benefits, you must submit an application to your state’s Medicaid office. Unlike programs like Medicare or the Health Insurance Marketplace, you can apply for Medicaid benefits any time of year.

Depending on where you live, you may be able to apply for Medicaid in the following ways:

Online
- When applying online, you can either apply directly with the federal government’s Health Insurance Marketplace (https://www.healthcare.gov/medicaid-chip/) or your state’s Medicaid website.
In person
By phone
By mail
By fax
By email

Medicaid Denials and Appeals

Your Medicaid application can be denied for many reasons. If your state or territory’s Medicaid agency believes you do not meet all the eligibility criteria, you will not receive Medicaid benefits. Although you can reapply for Medicaid in the future if your circumstances change, you can also appeal a denial if you believe you are entitled to Medicaid benefits.

Common Reasons for a Medicaid Denial

You will be denied Medicaid benefits if you do not meet all of the eligibility criteria outlined by your state or territory’s Medicaid agency. You can be denied for the following reasons:

Your income exceeds your state or territory’s limit.
You are not part of a covered population in your state or territory.
You are not a legal U.S. resident.
You have not met the five-year waiting period as a qualified non-citizen.

If you are denied Medicaid benefits, your state or territory will generally send you an eligibility determination notice detailing the reason that your application for Medicaid benefits was denied. This notice also describes the appropriate steps to take to file an appeal. This form may have a different name in some states and territories, such as a notice of denial or denial letter.

Requesting an Appeal

In many states and territories, you must request an appeal with the Medicaid agency. Some locations have a request form that you must complete, while others simply require you to send a letter expressing your request for an appeal. The specific information needed in a written request may vary slightly by location, but generally, you can expect to include the following information:

Your full name
- If you are requesting on behalf of your family member, be sure to include both your and your family member’s name.
- If you will be represented by someone other than yourself during a requested hearing, include the representative’s name and phone number in the event the Medicaid agency wishes to contact him or her.
Your home address
- Use the same home address you used on your Medicaid application.
Your phone number
The detailed reason for requesting an appeal
Any supporting documents that may help your case and prove your eligibility for Medicaid
A copy of the eligibility determination notice (if your state or territory sent you one)