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Medicaid: Mandatory Versus Optional Benefits

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    If you are enrolled in Medicaid then it is important for you to know what services you have a right to receive no matter what state you reside in and what services your states Medicaid board may or may not administer because they are considered "optional" benefits.

    Mandatory benefits are services every single Medicaid provider must provide regardless of location. These services include inpatient and outpatient hospital services, nursing facilities services, pediatric services, and many more.

    Below is a full list of every service that every single Medicaid recipient is eligible for:

    • Inpatient hospital services
    • Outpatient hospital services
    • EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services
    • Nursing Facility Services
    • Home health services
    • Physician services
    • Rural health clinic services
    • Federally qualified health center services
    • Laboratory and X-ray services
    • Family planning services
    • Nurse Midwife services
    • Certified Pediatric and Family Nurse Practitioner services
    • Freestanding Birth Center services (when licensed or otherwise recognized by the state)
    • Transportation to medical care
    • Tobacco cessation counseling for pregnant women

    There are many more optional services that, depending on the state you reside in, may or may not be available to Medicaid recipients. These services range from dental, vision, and other practitioner coverage to physical and occupational coverage. You will need to contact your state provider to see what services are provided in your state.

    I personally feel that far more services should be mandatory for all states and not optional. It's not fair, at least in my opinion, to tell someone who lives in a certain state that an invisible border is the reason why they can't get dental or vision services. Do you agree or do you think the current structure of mandating certain services and allowing the states to decide what other services they want to administer?

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    JaredS Wrote:

    I personally feel that far more services should be mandatory for all states and not optional. It's not fair, at least in my opinion, to tell someone who lives in a certain state that an invisible border is the reason why they can't get dental or vision services. Do you agree or do you think the current structure of mandating certain services and allowing the states to decide what other services they want to administer?

    Yeah. I just proposed a sorta similar question for unemployment benefits. The more you look into any benefits program, the more you start to see how things vary so much, just from state to state. I know this is par for the course when it comes to the federal govt dealing out certain funds and standards, where still a good deal is optional, and up for debate.

    Still seems wrong to be able to get a huge list of benefits in one state though. And then you drive over just one arbitrary state border, and everything changes. Turns into a situation of the haves and have-nots, just depending on where you decide to live. I am on the fence about what to do about it though. Standardizing spending takes away state's abilities to experiment and prove/disprove the legitimacy of certain programs, over time. So I see both pros and cons.

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    As someone that is trying to navigate the Medicaid system in Virginia I can’t believe that people still can’t receive the crucial help they need because someone decided it was optional. How is physical, occupational and speech therapy for someone optional? My son was in a motorcycle wreck and has a severe Traumatic Brain Injury there are no places that provide the care he needs in Virginia and the places that could help him get some part of his life back Medicaid won’t pay for!!!!