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.]