Senior’s Guide to Medicaid

seniors guide to medicaid cover

Senior’s Guide to Medicaid

You will learn about:
  • State and territory agency contact information
  • Eligibility requirements and documents you need to apply
  • What to do in case your application is denied

46 min – Estimated reading time

Senior’s Guide to Medicaid

Senior’s Guide to Medicaid

seniors guide to medicaid cover

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 

LocationMedicaid Program NameAdministrative DepaartmentMain Phone NumberOffice Locator
AlabamaAlabama MedicaidDepartment of Public Health1 (334) 242-5000https://medicaid.alabama.gov/content/10.0_Contact/10.1_Medicaid_Contacts/10.1.1_Medicaid_Locations.aspx
AlaskaAlaska MedicaidDepartment of Health and Social Services(800) 770-5650http://dhss.alaska.gov/dpa/Pages/contacts.aspx
ArizonaArizona Health Care Cost Containment SystemDepartment of Economic Security1 (855) 432-7587https://www.healthearizonaplus.gov/App/Enrollment_Entity_Search_results.aspx?link=Assistor
ArkansasArkansas MedicaidDepartment of Human Services(501) 682-8292https://humanservices.arkansas.gov/contact-us/ 
CaliforniaMedi-CalDepartment of Health Care Services Division(888) ​452-8609https://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx
ColoradoHealth First ColoradoDepartment of Human Services1 (800) 221-3943https://www.colorado.gov/cdhs/contact-your-county
ConnecticutHusky HealthDepartment of Social Services1 (877) 284-8759https://portal.ct.gov/dss/About-the-Department-of-Social-Services/Contact
DelawareDelaware MedicaidDivision of Medicaid and Medical Assistance(302) 571-4900https://dhss.delaware.gov/dhss/dmma/locations.html
District of ColumbiaDC MedicaidDepartment of Health Care Finance(202) 727-5355https://www.dc-medicaid.com/dcwebportal/nonsecure/medicaidAndMe
FloridaFlorida MedicaidDepartment of Children and Families(850) 300-4323https://www.myflfamilies.com/service-programs/access/map.shtml
GeorgiaGeorgia MedicaidDivision of Family and Children Services(404) 657-5468https://dfcs.georgia.gov/locations
HawaiiMed-QuestDepartment of Human ServicesOahu: (808) 524- 3370Elsewhere: 1 (800) 316-8005https://medquest.hawaii.gov/en/contact-us.html
IdahoIdaho MedicaidDepartment of Health and Welfare1 (877) 456-1233https://healthandwelfare.idaho.gov/contact-us 
IllinoisIllinois MedicaidDepartment of Healthcare and Family Services1 (800) 843-6154https://www.dhs.state.il.us/page.aspx?module=12&officetype=&county=
IndianaIndiana MedicaidOffice of Medicaid and Policy Planning1 (800) 457-4584https://secure.in.gov/apps/fssa/providersearch/map
IowaIowa MedicaidDepartment of Human Services1 (800) 338-8366https://dhs.iowa.gov/dhs_office_locator
KansasKanCareDepartment for Children and Families(800) 792-4884http://www.dcf.ks.gov/services/Pages/DCFOfficeLocatorMap.aspx
KentuckyKentucky MedicaidDepartment for Medicaid Services(855) 459-6328https://prd.webapps.chfs.ky.gov/Office_Phone/
LouisianaLouisiana MedicaidDepartment of Health1 (888) 342-6207http://ldh.la.gov/index.cfm/directory/category/158
MaineMaineCareDepartment of Health and Human Services1 (800) 977-6740https://gateway.maine.gov/dhhs-apps/office_finder/
MarylandMaryland MedicaidDepartment of Health and Mental Hygiene(410) 767-5800https://health.maryland.gov/docs/Contact%20Us%20Information.pdf
MassachusettsMassHealthDepartment of Health and Human Services(800) 841-2900https://www.mass.gov/service-details/masshealth-enrollment-centers-mecs
MichiganMichigan MedicaidDepartment of Health and Human Services1 (800) 642-3195https://www.michigan.gov/mdhhs/0,5885,7-339-73970_5461—,00.html
MinnesotaMinnesotaCareDepartment of Human Services(651) 431-2670https://mn.gov/dhs/people-we-serve/adults/health-care/health-care-programs/contact-us/county-tribal-offices.jsp
MississippiMississippi MedicaidDivision of Medicaid1 (888) 706-1535https://medicaid.ms.gov/about/office-locations/
MissouriMO HealthNetDepartment of Social Services(573) 751-3425https://dss.mo.gov/offices.htm
MontanaMontana MedicaidDepartmnet of Public Health and Human Services1 (888) 706-1535https://dphhs.mt.gv/hcsd/officeofpublicassistance
NebraskaNebraska MedicaidDepartment of Health and Human Services(402) 471-3121http://dhhs.ne.gov/Pages/Public-
Assistance-Offices.aspx
NevadaNevada MedicaidDepartment of Health and Human Services1 (800) 992-0900Northern Office Locations:
https://dwss.nv.gov/Contact/Welfare_District_Offices-North/
Southern Office Locations:
https://dwss.nv.gov/Contact/Welfare_District_Offices-
South/
New HampshireNew Hampshire MedicaidDepartment of Health and Human Services(603) 271-4344https://www.dhhs.nh.gov/contactus/districtoffices.htm
New JerseyNew Jersey MedicaidDivision of Medical Assistance and Health Services1 (800) 356-1561https://www.nj.gov/humanservices/njsnap/home/cbss.shtml
New MexicoCentennial CareHuman Services Department1 (888) 997-2583https://www.hsd.state.nm.us/lookingforassistance/contact-us/
New YorkNew York MedicaidDepartment of Health1 (800) 541-2831https://www.health.ny.gov/health_care/medicaid/ldss.htm
North CarolinaNorth Carolina MedicaidDivision of Health Benefits(888) 245-0179https://www.ncdhh.gov/divisions/social-services/local-dss-directory
North DakotaNorth Dakota MedicaidDepartment of Human Services(701) 328-7068http://www.nd.gov/dhs/locations/countysocialserv/
OhioOhio MedicaidDepartment of Medicaid1 (800) 324-8680https://jfs.ohio.gov/County/County_
Directory.pdf
OklahomaSoonerCareHealth Care Authority(800) 987-7767https://oklahoma.gov/health/countymap.html
OregonOregon Health PlanHealth Authority(800) 273-0557https://www.oregon.gov/DHS/
Offices/Pages/Self-Sufficiency.aspx
PennsylvaniaMedical AssistanceDepartment of Human Services1 (866) 550-4355https://www.dhs.
pa.gov/Services/Assistance/Pages/CAO-Contact.aspx
Rhode IslandRI MedicaidExecutive Office of Health and Human
Services
1 (855) 840-4774http://www.dhs.ri.gov/DHSOffices/index.php
South CarolinaHealthy Connections MedicaidDepartment of Health and Human Services(888) 549-0820https://www.scdhhs.gov/site-page/where- go-help
South DakotaSouth Dakota MedicaidDepartment of Social Services(605) 773-4678https://dss.sd.gov/findyourlocaloffice/
TennesseeTennCareDepartment of Human Services1 (800) 342-3145https://www.tn.gov/humanservices/for-families/supplemental-nutrition-assistance-program-snap/office-locator-family-assistance.html
TexasTexas MedicaidDepartment of Health and Human Services(800) 252-8263https://www.dshs. texas.gov/regions/
default.shtm
UtahUtah Medicaid

 

Department of HealthSalt Lake City: (801) 538-6155
Other Locations: 1 (800) 662-9651
https://jobs.utah.gov/jsp/officesearch/#/map
VermontVermont Medicaid

 

Department of Vermont Health
Access
(802) 879-5900https://www.healthvermont.gov/local
VirginiaCover VirginiaDepartment of Social Services1 (855) 242-8282https://coverva.org/findhelp/
WashingtonApple HealthHealth Care Authority1 (800) 562-3022https://www.hca.wa.gov/assets/
free-or-low-cost/community_based_staff_contact.pdf
West VirginiaWest Virginia MedicaidDepartment of Health and Human Resources1 (877) 716-1212https://dhhr.wv.gov/pages/field-offices.
aspx
WisconsinBadgerCareDepartment of Health(608) 266-1865https://www.dhs.
Services
wisconsin.gov/forwardhealth/
imagency/index.htm
WyomingWyoming MedicaidDepartment of Health(307) 777-7531https://wymedicaid.portal.conduent.com/Webportal/DFS_Offices_by_County.
pdf

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 home services
  • Home health services
  • Physician services
  • Lab and x-ray services
  • Family planning services
  • Rural health clinic services
  • Early and periodic screening, diagnostic and treatment (EPSDT) services
  • Federally qualified health center services
  • Nurse midwife services
  • Certified pediatric and family nurse practitioner services
  • Freestanding birth center services, when state-approved
  • Medical transportation services
  • Tobacco cessation counseling services for pregnant women

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: 

  • Prescription drug coverage
  • Clinic services
  • Physical therapy
  • Occupational therapy
  • Speech, hearing and language disorder services
  • Respiratory care services
  • Other diagnostic, screening, preventative and rehabilitative services
  • Podiatry services
  • Optometry services
  • Dental services
  • Denture coverage
  • Prosthetics coverage
  • Eyeglasses coverage
  • Chiropractic services
  • Other practitioner services
  • Private duty nursing services
  • Personal care
  • Hospice care
  • Case management 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
  • State plan home and community-based services
  • Self-directed personal assistance services
  • Community-first choice options
  • Tuberculosis-related services
  • Inpatient psychiatric services for individuals under 21 years of age
  • Health homes for individuals with chronic conditions
  • Other approved services

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.

Guam

Comprehensive information about covered services is not readily available. To learn about all services offered, contact the Bureau of Economic Security (BES) at (671) 635-7432.

Guam provides all mandatory benefits. Examples of optional benefits in Guam include dental care and prescription drug coverage. 

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
  • Prescription drugs
  • Medical supplies
  • Physical and occupational therapy
  • Prosthetics
  • Rehabilitative Services
  • Speech, Hearing and Language Disorders
  • Vision services and eyeglasses
  • Wheelchairs

Puerto Rico

Comprehensive information about covered services is not readily available. To learn about all services offered, contact the Department of Health at (787) 765-2929 ext. 6700.

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 dental care and prescription drugs. 

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:

  1. 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).
  2. Family size
    • The total number of people living in the applicant’s home.
  3. Citizenship

Most states require Medicaid beneficiaries to earn somewhere below 138 percent of the FPL to qualify for Medicaid. The 2021 FPL chart is as follows:

Family SizeAnnual Income Limit
1 person$12,880
2 people$17,420
3 people$21,960
4 people$26,500
5 people$31,040
For each additional member+$4,540

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
  • 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:

  1. 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.
  2. Your home address
    • Use the same home address you used on your Medicaid application.
  3. Your phone number
  4. The detailed reason for requesting an appeal
  5. Any supporting documents that may help your case and prove your eligibility for Medicaid
  6. A copy of the eligibility determination notice (if your state or territory sent you one)

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