Medicaid provides health care coverage for some children living in low-income families. Specific health care conditions, like long-term disabilities, can also result in Medicaid coverage. Children living in foster care are eligible as well. Mandated by federal law and administered by individual states, Medicaid provides a wide range of benefits for children. (Reference 2 & 3)
Medical Care
Inpatient hospital coverage is provided by Medicaid and will cover any charges that occur from a hospital stay or an emergency room visit. Outpatient medical services are provided by Medicaid too. This includes trips to the doctor when your child is sick, lab work she may need to have done and x-rays or other radiology exams. Home health services may also be available in specific situations. (Reference 3) Most medical prescriptions are covered as well.
Dental Care
Medicaid covers routine dental care. Your child can receive regular dental check-ups and cleanings if he has Medicaid. Treatment for cavities, pain and infection are also covered. Restoration of teeth, emergency dental care and dental surgery are included as well. Braces and orthodontist visits, however, are typically not covered when they are being utilized only for cosmetic reasons. (Reference 1)
Therapy Services
Certain therapy services are provided for your child under specific conditions. Therapy services--such as speech therapy and occupational therapy--must be provided by a federally qualified health center, hospital or clinic. If your child's therapist is in private practice and not Medicaid approved, the charges won't be covered. Discuss your child's health care coverage with the therapist prior to any appointments to avoid unforeseen expenses. (Reference 3)
Preventative Care
Preventative care services are covered by Medicaid. This includes a broad range of care areas, including routine well-child checks and immunizations. It also includes routine vision and hearing screenings and care. (Reference 1) Preventative care helps to catch medical and developmental issues early, allowing your child to receive services sooner. Preventative care also provides an opportunity for you to discuss concerns you have about your child with her provider.
Nursing Services
Certified family and pediatric nurse practitioner services are covered by Medicaid when the practitioner is licensed by the state. If your child has special needs that require nursing services, these may also be covered by Medicaid if they are provided by a qualified health center or rehabilitation center. (Reference 1)
Limitations
It's important to make sure that any health care provider who cares for your child is an approved Medicaid provider. Ask the provider if he accepts Medicaid coverage before any treatment is done whenever possible. Keep in mind that some medications and treatments may need pre-authorization or may be denied. For example, some medications may be denied coverage by Medicaid until a generic equivalent has been tried.
Additional Services
Because the Medicaid program works as a partnership between the federal and state government, many aspects of the program are left for the individual states to determine. The state you live in is free to adapt and expand the program as long as they meet the minimum requirements and are in compliance with federal law. This means that there maybe additional services provided for your child by the state you live in. Individual state information is available at InsureKidsNow.gov. (See Resource 1)
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