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Mandatory & Optional Medicaid Benefits

This page outlines mandatory and optional Medicaid state plan benefits and the relevant section of the Social Security Act and applicable coverage regulation(s) under which each benefit is authorized.  States are required to provide all mandatory benefits under federal law.  States may provide optional benefits  if they choose to add them through the state plan process.

Mandatory Benefits

  • Transportation to medical care (1902(a)(4), 42 CFR 431.53 and 42 CFR 440.170)
  • Inpatient hospital services (1905(a)(1), 42 CFR 440.10)
  • Outpatient hospital services (1905(a)(2)(A), CFR 440.20(a))
  • Rural health clinic services (1905(a)(2)(B), 42 CFR 440.20(b))
  • Federally qualified health center services (1905(a)(2)(C))
  • Laboratory and X-ray services (1905(a)(3), 42 CFR 440.30, and 42 CFR 441.17)
  • Nursing facility services (1905(a)(4)(A), 42 CFR 440.40 and 42 CFR 440.155)
  • Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services (1905(a)(4)(B), 1905(r), 42 CFR 440.40, 42 CFR 441 Subpart B)
  • Family planning services (1905(a)(4)(C), 42 CFR 441.20)
  • Tobacco cessation counseling for pregnant women (1905(a)(4)(D))
  • Physician services (1905(a)(5), 42 CFR 440.50)
  • Home health services (1905(a)(7), 42 CFR 440.70 and 42 CFR 441.15)
  • Nurse Midwife services (1905(a)(17), 42 CFR 440.165 and 42 CFR 441.21)
  • Certified pediatric and family nurse practitioner services (1905(a)(21), 42 CFR 440.166(b) and 42 CFR 441.22)
  • Freestanding birth center services when licensed or otherwise recognized by the state (1905(a)(28))
  • Medication Assisted Treatment (MAT) (1905(a)(29))
  • Routine patient costs of items and services for beneficiaries enrolled in qualifying clinical trials (1905(a)(30))

Optional Benefits

*The ABP is mandatory for the Medicaid expansion population. 
**This includes services furnished in a religious nonmedical health care institution, emergency hospital services by a non-Medicare certified hospital, and critical access hospital (CAH).