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Items Not Covered By Medicaid (Short Sampling)

The following list (which is not all encompassing of non-covered items) contains items which are deemed "Optional Benefits" per the federal Medicaid program guideline. Coverage varies by state.

 

  • Clinic services
  • Physical therapy
  • Occupational therapy
  • Speech, hearing and language disorder services
  • Respiratory care services
  • Podiatry services
  • Optometry services
  • States are required to provide dental care for children up to age 18, but it is optional for adults. Most states provide only emergency dental. Less than 50% of states have any coverage at all for adults beyond emergency care)
  • Dentures
  • Prosthetics
  • Eyeglasses
  • Chiropractic services
  • Other practitioner services
  • Private duty nursing services
  • Personal Care
  • Case Management
  • Hospice (in some states, hospice care has limited coverage which suspends all other Medicaid benefits meant to treat the terminal illness or prolong life)
  • Some specialty drugs (also varies by state)
  • Barbiturates, benzodiazepines, some antihistamines/decongestants/expectorants, some anticonvulsants, some anti-anxiety medications, ophthalmics, some insulin products, topical antibiotics, vaginal antifungals, B12 injections, folic acid, vitamin K, (preceding list varies by state)
  • Prescription drug co-pays, which vary by state and are typically $3 to $5 per Rx.
  • Over-the-counter medications

 

 

  • THIS IS NOT AN ALL-INCLUSIVE LISTING.  Please refer to medicare.gov or your state's Medicaid website for a more complete listing.