Medicaid covers a broad range of medical services, from doctor visits and hospital stays to prescriptions, mental health care, and nursing home stays. The federal government sets a baseline of services every state must provide, but states can add optional benefits on top of that. This means your exact coverage depends on where you live.
Services Every State Must Cover
Federal law requires all state Medicaid programs to cover a core set of benefits. These are non-negotiable regardless of which state you live in:
- Doctor visits, including services from physicians, nurse practitioners, and nurse midwives
- Hospital care, both inpatient stays and outpatient services
- Lab work and X-rays
- Nursing facility services for people who need long-term or skilled nursing care
- Home health services, including nursing care and medical supplies delivered at home
- Family planning services
- Transportation to medical appointments
- Medication-assisted treatment for opioid use disorders, including all FDA-approved medications
- Comprehensive preventive care for children under a program called Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
A few other required benefits are more situation-specific. Pregnant women are entitled to tobacco cessation counseling, freestanding birth center services, and midwife care. Children receiving hospice can also receive treatment for their condition at the same time, rather than having to choose one or the other.
Services That Vary by State
Beyond the mandatory list, each state decides whether to offer additional “optional” benefits. Common examples include prescription drugs, physical therapy, occupational therapy, dental care for adults, vision services, hearing aids, and prosthetic devices. Nearly every state covers prescription drugs, but coverage for things like adult dental and vision care is far less consistent.
Adult dental coverage is a good example of how much state decisions matter. There are no federal minimum requirements for adult dental benefits under Medicaid. Some states cover a full range of preventive and restorative dental work, while others limit coverage to emergency extractions or pain relief. Children, by contrast, are guaranteed dental coverage through the EPSDT benefit.
To find out exactly what your state covers, your best resource is your state Medicaid agency’s website or a local enrollment counselor.
Prescription Drug Coverage
Although prescription drugs are technically an optional benefit, every state currently covers outpatient medications. The way it works behind the scenes shapes what you can actually get at the pharmacy. States maintain preferred drug lists, which are rosters of medications chosen for their effectiveness and cost. If your doctor prescribes a drug on the preferred list, it gets filled without extra steps. If the drug is not on the list, you or your doctor may need to go through a prior authorization process to get it approved.
States negotiate rebates with drug manufacturers to bring costs down, and 46 states plus Washington, D.C. have secured additional supplemental rebates beyond what the federal government requires. These rebate arrangements help keep the program financially sustainable while still covering a wide range of medications.
Mental Health and Substance Use Treatment
Medicaid is the single largest payer of behavioral health services in the United States, covering both mental health and substance use treatment. That includes therapy, counseling, and psychiatric services. For substance use disorders specifically, Medicaid pays for counseling appointments, life-saving medications like naloxone (used to reverse opioid overdoses), and treatment medications for opioid, alcohol, and nicotine use disorders. States are required to cover all FDA-approved medications for opioid use disorder treatment.
Many states go further, offering residential treatment programs, community-based support services, and mobile crisis teams that can respond to behavioral health emergencies outside of a hospital setting.
Nursing Home and Long-Term Care
Nursing facility care is one of Medicaid’s most significant benefits. Medicaid is the primary payer for long-term nursing home stays in the U.S., stepping in when other payment options are unavailable and the person meets eligibility requirements. To qualify, you must meet your state’s “level of care” criteria, which essentially means demonstrating that you need the kind of ongoing medical or personal assistance a nursing home provides.
Once you’re in a Medicaid-certified nursing facility, the program covers a comprehensive package of services you cannot be charged for: nursing care, rehabilitative services, pharmaceutical services, medically related social services, dietary services tailored to your needs, dental emergencies, room and bed maintenance, routine personal hygiene items, and an activity program. People with serious mental illness or intellectual disability go through an additional screening to confirm that a nursing facility is the right setting for their needs.
You can be charged for extras like a private room (unless medically necessary), personal comfort items, telephone and television access, personal clothing, and special food requests beyond what the facility normally prepares.
Home and Community-Based Services
For people who need ongoing support but want to stay in their own homes rather than move to a facility, Medicaid offers home and community-based services (HCBS) through waiver programs. These programs can cover a combination of medical and non-medical support: case management, homemaker services, home health aides, personal care assistance, adult day programs, residential habilitation, and respite care (temporary relief for family caregivers). States can also design custom services aimed at helping people transition out of institutional settings and back into the community.
Pregnancy and Postpartum Coverage
Medicaid covers prenatal care, labor and delivery, and postpartum services. Historically, pregnancy-related Medicaid coverage ended 60 days after delivery. That left many new mothers without insurance during a critical recovery period. As of early 2026, 49 states and Washington, D.C. have extended postpartum coverage to a full 12 months, with one remaining state planning to follow. This extension covers the same range of Medicaid services the mother was receiving during pregnancy, not just pregnancy-related care.
Children’s Coverage Under EPSDT
Children and adolescents on Medicaid get one of the most comprehensive benefit packages in the program. EPSDT requires states to provide regular checkups, vision and hearing screenings, dental care, immunizations, and lab tests. The key feature of EPSDT is that if a screening identifies a health problem, Medicaid must cover the treatment, even if that treatment is not otherwise included in the state’s Medicaid plan for adults. This makes children’s Medicaid coverage significantly broader than what adults receive in most states.
Transportation to Medical Care
One benefit many people don’t realize they have is transportation to and from medical appointments. Federal regulations require every state Medicaid program to ensure that enrollees can get to their providers. This is sometimes called non-emergency medical transportation, or NEMT. It can include bus passes, van services, mileage reimbursement, or rides through transportation companies. Drivers must have valid licenses, pass background checks against federal exclusion lists, and meet state requirements around drug violations and driving history.
Coverage for People With Both Medicare and Medicaid
If you qualify for both Medicare and Medicaid (known as “dual eligibility”), Medicaid can help cover costs that Medicare leaves behind. Your state will pay your Medicare Part B premium. Depending on your level of Medicaid eligibility, the state may also cover Medicare deductibles, copayments, and coinsurance. If you would otherwise have to pay a premium for Medicare Part A (hospital insurance), Medicaid can pick that up too. Dual-eligible individuals also automatically receive Extra Help, a program that lowers prescription drug costs under Medicare Part D.