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Medicaid Law: Federal and Ohio: Federal Laws

Federal Medicaid Law has three main parts. The first is who is eligible for Medicaid. This differs partly depending on whether your state has expanded its program.

  • In all states: You can qualify for Medicaid based on income, household size, disability, family status, and other factors. Eligibility rules differ between states.
  • In states that have expanded Medicaid eligibility: You can qualify based on your income alone. If your household income is below 133% of the federal poverty level, you qualify. (Because of the way this is calculated, it turns out to be 138% of the federal poverty level. A few states use a different income limit.)
  • Ohio has expanded Medicaid. See the Ohio page of this guide for more information.

The second aspect of Federal Medicaid Law is which services are covered. Federal law breaks this down into mandatory and optional services.

The list below outlines mandatory Medicaid benefits, which states are required to provide under federal law, and optional benefits that states may cover if they choose. Source : Medicaid.gov

Mandatory Benefits

Optional Benefits

Inpatient hospital services

Prescription Drugs

Outpatient hospital services

Clinic services

EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services

Physical therapy

Nursing Facility Services

Occupational therapy

Home health services

Speech, hearing and language disorder services

Physician services

Respiratory care services

Rural health clinic services

Other diagnostic, screening, preventive and rehabilitative services

Federally qualified health center services

Podiatry services

Laboratory and X-ray services

Optometry services

Family planning services

Dental Services

Nurse Midwife services

Dentures

Certified Pediatric and Family Nurse Practitioner services

Prosthetics

Freestanding Birth Center services (when licensed or otherwise recognized by the state)

Eyeglasses

Transportation to medical care

Chiropractic services

Tobacco cessation counseling for pregnant women

Other practitioner services

 

Private duty nursing services

 

Personal Care

 

Hospice

 

Case management

 

Services for Individuals Age 65 or Older in an Institution for Mental Disease (IMD)

 

Services in an intermediate care facility for Individuals with Intellectual Disability

 

State Plan Home and Community Based Services- 1915(i)

 

Self-Directed Personal Assistance Services- 1915(j)

 

Community First Choice Option- 1915(k)

 

TB Related Services

 

Inpatient psychiatric services for individuals under age 21

 

Other services approved by the Secretary*

 

Health Homes for Enrollees with Chronic Conditions – Section 1945

*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).

 

Waivers are the third prong of the federal Medicaid program. They allow states to waive the income qualification requirements for certain certain children and adults, so that they can live at home instead of being institutionalized.

US Code

Federal Regulations