Medicaid is a health insurance program that helps millions of people in the U.S. pay for medical care.

It mainly supports people with low incomes, people with disabilities, people with long-term health conditions, and people facing high medical bills.

What Medicaid covers can be different depending on:
 

1. The state you live in
2. Your age
3. The type of Medicaid plan you have

Even though states run their own Medicaid programs, federal law says every state must cover certain basic services.

States can also choose to cover extra services, like dental or vision care. In general, children and teens usually get more covered services than adults, especially for preventive care and dental care.

Below is an easy-to-understand breakdown of what Medicaid must cover, what children get through special rules, and what extra services some states may offer.
 

Services Medicaid Must Cover (In Every State)

Federal rules require all state Medicaid programs to cover certain core services for both adults and children (though the exact details can vary by state or plan).

These required services include:
 

• Doctor visits (outpatient care): Visits to a doctor’s office for checkups, diagnosing problems, treatment, rehab, or comfort care.
• Hospital care: Care when you are admitted to a hospital or stay overnight.
• Care at rural health clinics and federally qualified health centers: Services at approved clinics that serve many Medicaid patients.
• Emergency room visits: ER visits for emergencies and non-emergencies, though you may have a copay.
• Lab tests and X-rays: Tests used for routine screening or diagnosing a health issue.
• Nursing home or assisted living services (for those who qualify): Medicaid may cover some assisted living costs, but usually not all.
• Home health care (for those who qualify): Skilled nursing care at home, help from home health aides, and some medical supplies and equipment.
• Family planning and pregnancy care: Birth control and family planning services, plus care during pregnancy and childbirth (including services like counseling to help pregnant people stop using tobacco).
• Medication Assisted Treatment (MAT): Medication for substance use disorders, along with counseling and behavioral therapy related to treatment.
• Routine costs for approved clinical trials: If you are in a qualifying clinical trial, Medicaid can cover services related to preventing, diagnosing, monitoring, or treating complications from the trial.
• Transportation to covered care: If you don’t have another way to get to appointments, Medicaid may cover emergency and non-emergency transportation.
• Extra Coverage for Children and Teens (Under 21): EPSDT

Children and teens under age 21 get special Medicaid coverage through a federal rule called EPSDT, which stands for Early and Periodic Screening, Diagnostic, and Treatment.

EPSDT requires states to cover services that are medically necessary to fix or improve a child’s physical or mental health condition—even if that service is not usually covered for adults.

Under EPSDT, children may get additional benefits such as:
 

• Regular well-child visits: Routine checkups to track growth and development.
• Developmental and behavioral screenings: Tests to find learning, emotional, or behavior concerns early.
• Vision care: Eye exams and eyeglasses when needed.
• Hearing care: Hearing tests and hearing aids when needed.
• Dental care: Dental services to prevent or treat pain and infection, repair teeth, maintain dental health, and medically needed orthodontic care.
• Vaccines and immunizations: Coverage for all recommended vaccines for the child’s age.
• Diagnostic care: Tests and services needed to diagnose health conditions.

Children can also receive:
 

• Hospice care while still getting other treatment
• Services from certified pediatric and family nurse practitioners

 

Optional Medicaid Benefits (Varies by State, Mostly for Adults)

States can choose to offer extra Medicaid benefits beyond the required services, especially for adults. These optional benefits can be very different depending on where you live.

Common optional benefits include (but are not limited to):
 

• Prescription drugs: This is technically optional under federal law, but all states currently cover prescription medications.
• Dental care for adults: Some states cover only emergency dental care, while others may cover routine cleanings, fillings, dentures, and more.
• Vision care for adults: Some states cover eye exams and glasses for adults, while others mainly cover vision care for children.
• Hearing services: Hearing exams and sometimes hearing aids.
• Physical, occupational, or speech therapy
• Mental health and psychiatric care
• Chiropractic care or podiatry care
• Hospice care

 

Key Takeaway

Medicaid always covers certain basic health services, but the exact coverage depends on your state, your age, and your plan. Children and teens often receive more complete coverage through EPSDT.

Many states also add optional services—especially things like prescriptions, dental, vision, therapy, and mental health care—though what’s included can vary widely.

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