You May Qualify for Medicaid – Here’s What It Covers

Am I eligible for Medicaid?

Your modified adjusted gross income (MAGI) determines your financial eligibility for Medicaid and Children’s Health Insurance Program (CHIP), as well as premium tax credits and cost-sharing reductions that may be available through the health insurance marketplace.

Medicaid determines your eligibility as a percentage of your income, but it also considers the number of people in your household. In most cases, the limit is 138% of the federal poverty level (FPL). This percentage varies by state, ranging from 0% for adults without children to as high as 221% for families of three in the District of Columbia.

Nonfinancial eligibility requirements

To qualify for Medicaid, you must also meet nonfinancial requirements, such as:

• being a United States citizen or a lawful permanent resident
• living in the state in which you apply
• being considered “medically needy,” which is for people with considerable health needs but whose income is too high to otherwise qualify for Medicaid.

State-specific rules

While Medicaid covers all enrollees for certain services, the details and scope of coverage for many services depend on the state.

If you qualify for Medicaid, your state determines the type, amount, duration, and scope of services within the broad federal Medicaid guidelines.

The best way to find out what Medicare may cover is to consult the Medicaid website for your state.

What does Medicaid cover?

Everyone covered by Medicaid across all 50 states can access the following services.

Hospital services

• Inpatient hospital services: This includes any care that a person receives when they stay overnight in the hospital.
• Outpatient hospital services: This includes lab tests like bloodwork, minor surgeries that don’t require overnight hospitalizations, colonoscopies, mammograms, routine physical exams and follow-ups, and imaging services, including MRIs, CT scans, and X-rays.

Doctor and clinic visits

Visits include routine exams and follow-up visits with local doctors. These include private offices, rural health clinics, and federally qualified health center services.

Pregnancy services

Pregnancy care includes prenatal visits, labor and delivery, including midwife services, and all medically necessary services directly or indirectly related to the pregnancy.

Pediatric services

Pediatric services include preventive care and screenings for children and teenagers up to 19 years old.

Screening services

These are collectively known as early and periodic screening, diagnostic, and treatment services (EPSDT). They’re part of preventive healthcare, and include screenings for common chronic, infectious, and cancer diseases.

Transportation for medical care

This includes transportation for emergency care, such as an ambulance or a medical flight, and transportation for nonemergency care, such as from a ride service. Keep in mind that states differ on when they say rides are necessary.

Outpatient prescription drugs

All 50 states currently provide coverage for outpatient prescription drugs to all eligible individuals.

Coverage that varies by state

You may be covered for many other healthcare products and services, too.

Here are the types of care that vary by state.

Optional benefits

Optional benefits depend on your state and vary in scope, including:

• prescription drugs
• physical and occupational therapy
• speech
• hearing and language disorder services
• optometry services
• dental services
• chiropractic services
• prosthetics
• private nursing
• hospice care

Physical therapy and other services

All 50 states allow coverage for physical therapy in some form.

However, some states have limitations on the number of sessions covered, where the sessions take place, whether a referral is needed, and the copayment costs.

Products and devices

• Eyeglasses: Medicaid covers eyeglasses in all 50 states. Medicaid covers eyeglasses in all 50 states. However, the states limit how often you can replace them depending on age.
• Hearing aids: 28 states cover them, but to varying degrees.
  • 12 states cover hearing aids if the patient has “mild” or greater hearing loss, such as difficulty understanding soft speech when there’s a lot of background noise, like in a restaurant.
  • 6 states require you to have “moderate” or greater hearing loss.
  • 6 other states rely on opinions from audiologists and physicians, as there reportedly aren’t any set limits for coverage.
  • 4 states don’t have explicit criteria around hearing loss severity.
• Dentures: Medicaid covers the cost of dentures in some form in all 50 states, but often has severe limitations on who qualifies and whether the person requires partial or full dentures. You may also require prior authorization.
• Prosthetics and orthotic devices: All 50 states cover them in some form. Some states have limitations based on who qualifies, and others, like Mississippi, will only cover a percentage of the cost.
• Medical equipment: Covered by Medicaid in all 50 states with restrictions. You may need prior authorization, and Medicaid limits the disbursement frequency of devices like breast pumps and equipment like wheelchairs.

Specialist doctor visits

Here are the specialist doctors Medicaid covers across all states, plus how each may be limited in scope depending on the state:

• Dental services: Covered by Medicaid in most states, but often limited to routine cleanings and preventive care. Your coverage may also have age limitations — some states only offer it for people ages 21 years and younger.
• Podiatrist: Accessing podiatrist services in all 50 states using Medicaid usually means you need a referral and prior authorization to demonstrate it’s a medical necessity for you.
• Optometrist: Provided in all 50 states with a referral and prior authorizations, but there’s a limited scope of care you can access.
• Psychologist: Provided with a referral and prior authorizations in all 50 states, but there may be a limited scope of care.
• Chiropractor: Of the 24 states that cover chiropractic care under Medicaid, 13 charge beneficiaries a small copayment up to $3.80 per session for chiropractic treatment. Some also limit the amount of chiropractic care you can get through the program. For example, they may limit the number of visits funded per year, while others place an annual funding cap on chiropractic treatment per enrollee.

Comprehensive healthcare services for children

As of April 2025, 14 states provide comprehensive state-funded coverage for all income-eligible children regardless of immigration status.

Rehabilitation services for mental health and substance use disorder

Medicaid may cover rehabilitation services for mental health and substance use disorder. However, there are limitations based on the type of service and even where the service is provided. Prior authorization is always required.

Takeaway

Medicaid will cover specific medical care services in all 50 states, but some benefits are state-specific.

If you live in the District of Columbia or one of the 40 states that have expanded Medicaid, you may be eligible for more services.

You can call Medicaid toll-free at 877-267-2323 (TTY: 800-877-8339).