Federal Requirements and State Options: Benefits

Download Publication (pdf)

March 2017 | Benefits

States have broad flexibility to create a benefit package for their Medicaid enrollees within federal guidelines. Certain benefits are mandatory—for example, inpatient and hospital outpatient services and services at rural health clinics and federally qualified health centers (FQHCs). Other services such as adult dental care, eyeglasses, and personal care services may be offered at the discretion of the state.

This fact sheet examines state options for covering Medicaid benefits, including flexibilities in determining which benefits and how much of a service to cover, benchmark coverage, and use of waivers to modify benefit packages.

From: Federal Requirements and State Options: How states exercise flexibility under a Medicaid state plan

Publication Type: Fact Sheets

Tags: 1915(b) freedom of choice waivers, 1915(c) home and community-based services waivers, benefits, Early and Periodic Screening Diagnostic and Treatment (EPSDT), mandatory services, optional services, prescription drugs, Section 1115 research and demonstration project waivers, waivers