According to 42 U.S.C.A. §
1396a, the list of services which must be provided to
Medicaid recipients is found in (1) through (5), as well as
(17) and (21) of 42 USC §1396d.
So, what is in the list at 42 USC §1396d? Here is the complete
list. Items which are required are marked with * meaning the
state must provide these services.
*(1) inpatient hospital services (other than services in
an institution for mental diseases);
*(2)
(A) outpatient hospital services,
(B) consistent with State law permitting such services, rural
health clinic services (as defined in subsection (l)(1) of
this section) and any other ambulatory services which are
offered by a rural health clinic (as defined in subsection
(l)(1) of this section) and which are otherwise included in
the plan, and
(C) Federally- qualified health center services (as defined
in subsection (l)(2) of this section) and any other ambulatory
services offered by a Federally-qualified health center and
which are otherwise included in the plan;
*(3) other laboratory and X-ray services;
*(4)
(A) nursing facility services (other than services in an institution
for mental diseases) for individuals 21 years of age or older;
(B) early and periodic screening, diagnostic, and treatment
services (as defined in subsection (r) of this section) for
individuals who are eligible under the plan and are under
the age of 21; and
(C) family planning services and supplies furnished (directly
or under arrangements with others) to individuals of child-bearing
age (including minors who can be considered to be sexually
active) who are eligible under the State plan and who desire
such services and supplies;
*(5)
(A) physicians' services furnished by a physician (as defined
in section 1395x(r)(1) of this title), whether furnished in
the office, the patient's home, a hospital, or a nursing facility,
or elsewhere, and
(B) medical and surgical services furnished by a dentist (described
in section 1395x(r)(2) of this title) to the extent such services
may be performed under State law either by a doctor of medicine
or by a doctor of dental surgery or dental medicine and would
be described in clause (A) if furnished by a physician (as
defined in section 1395x(r)(1) of this title);
(6) medical care, or any other type of remedial care recognized
under State law, furnished by licensed practitioners within
the scope of their practice as defined by State law;
(7) home health care services;
(8) private duty nursing services;
(9) clinic services furnished by or under the direction of
a physician, without regard to whether the clinic itself is
administered by a physician, including such services furnished
outside the clinic by clinic personnel to an eligible individual
who does not reside in a permanent dwelling or does not have
a fixed home or mailing address;
(10) dental services;
(11) physical therapy and related services;
(12) prescribed drugs, dentures, and prosthetic devices;
and eyeglasses prescribed by a physician skilled in diseases
of the eye or by an optometrist, whichever the individual
may select;
(13) other diagnostic, screening, preventive, and rehabilitative
services, including any medical or remedial services (provided
in a facility, a home, or other setting) recommended by a
physician or other licensed practitioner of the healing arts
within the scope of their practice under State law, for the
maximum reduction of physical or mental disability and restoration
of an individual to the best possible functional level;
(14) inpatient hospital services and nursing facility services
for individuals 65 years of age or over in an institution
for mental diseases;
(15) services in an intermediate care facility for the mentally
retarded (other than in an institution for mental diseases)
for individuals who are determined, in accordance with section
1396a(a)(31) of this title, to be in need of such care;
(16) effective January 1, 1973, inpatient psychiatric hospital
services for individuals under age 21, as defined in subsection
(h) of this section;
*(17) services furnished by a nurse-midwife (as defined in
section 1395x(gg) of this title) which the nurse-midwife is
legally authorized to perform under State law (or the State
regulatory mechanism provided by State law), whether or not
the nurse-midwife is under the supervision of, or associated
with, a physician or other health care provider, and without
regard to whether or not the services are performed in the
area of management of the care of mothers and babies throughout
the maternity cycle;
(18) hospice care (as defined in subsection (o) of this section);
(19) case-management services (as defined in section 1396n(g)(2)
of this title) and TB-related services described in section
1396a(z)(2)(F) of this title;
(20) respiratory care services (as defined in section 1396a(e)(9)(C)
of this title);
*(21) services furnished by a certified pediatric nurse practitioner
or certified family nurse practitioner (as defined by the
Secretary) which the certified pediatric nurse practitioner
or certified family nurse practitioner is legally authorized
to perform under State law (or the State regulatory mechanism
provided by State law), whether or not the certified pediatric
nurse practitioner or certified family nurse practitioner
is under the supervision of, or associated with, a physician
or other health care provider;
(22) home and community care (to the extent allowed and as
defined in section 1396t of this title) for functionally disabled
elderly individuals; and
(23) community supported living arrangements services (to
the extent allowed and as defined in section 1396u of this
title);
(24) personal care services furnished to an individual who
is not an inpatient or resident of a hospital, nursing facility,
intermediate care facility for the mentally retarded, or institution
for mental disease that are
(A) authorized for the individual by a physician in accordance
with a plan of treatment or (at the option of the State) otherwise
authorized for the individual in accordance with a service
plan approved by the State,
(B) provided by an individual who is qualified to provide
such services and who is not a member of the individual's
family, and
(C) furnished in a home or other location;
(25) primary care case management services (as defined in
subsection (t) of this section);
(26) services furnished under a PACE program under section
1396u-4 of this title to PACE program eligible individuals
enrolled under the program under such section; and
(27) any other medical care, and any other type of remedial
care recognized under State law, specified by the Secretary,
except as otherwise provided in paragraph (16), such term
does not include--
(A) any such payments with respect to care or services for
any individual who is an inmate of a public institution (except
as a patient in a medical institution); or
(B) any such payments with respect to care or services for
any individual who has not attained 65 years of age and who
is a patient in an institution for mental diseases.
[NOTE: paragraphs marked with * are required; that is, the
state must provide those services. The other paragraphs are
optional, depending on the state’s contract with HCFA.]