Medicaid FAQs - Federally Mandated Services

  
       Child Health Services (EPSDT) Family Planning Services Federally Qualified Health Center Home Health Services Inpatient Hospital Services Laboratory and X-Ray Services Nurse-Midwife Services Nurse Practitioner Services Nursing Facility Services Outpatient Hospital Services Physician Services Rural Health Clinic Services Details of Federally Mandated Medicaid Services Early and Periodic Screening, Diagnosis and Treatment (EPSDT) for Persons Under Age 21 (Child Health Services Program) Beneficiaries in the Child Health Services (EPSDT) Program are eligible for Medicaid benefits. The Child Health Services (EPSDT) Program is a free, preventive health care service for all Medicaid beneficiaries younger than 21. Mothers and fathers who are younger than 21 may participate in this program. Most PCPs in Arkansas participate in the Child Health Services (EPSDT) Program. The PCP or other Child Health Services (EPSDT) Program provider performs regular checkups and gives immunizations for childhood diseases. The provider explains any conditions needing further medical attention and arranges referrals to other physicians if necessary. The following Medicaid-covered services are available to beneficiaries younger than 21 through the Child Health Services (EPSDT) Program: eye prostheses repairs and replacements of eyeglasses hearing aid services (These benefits require prior approval by Medicaid and are subject to a benefit limit.) immunizations allergy/desensitization injections and antigens (Medicaid covers all medically necessary allergy shots, immunizations, and injections. The injections must be prescribed as a result of an EPSDT screening or referral.) Child Health Management Services (CHMS) inpatient psychiatric care. (Medicaid pays only for medically necessary psychiatric treatment. All inpatient psychiatric admissions and the length of stay for each admission require approval from the Division of Medical Services.) cochlear implantation Durable Medical Equipment (DME) psychology services occupational, physical, and speech therapy services (A physician must prescribe therapy services. Beneficiaries age 21 and older are not eligible to receive therapy services through the Therapy Program.) Additional services may be covered if an EPSDT screening determines they are medically necessary. These services include, but are not limited to targeted case management services for beneficiaries younger than 21 orthotic appliances prosthetic devices respiratory care services Family Planning Services Medicaid covers family planning services for persons who are of childbearing age. Medicaid patients can get family planning services through local county health department offices or in physicians' offices. Family planning examinations, related laboratory services, and family planning prescriptions do not count against benefit limits for physician, laboratory, and prescription services. There is no benefit limit on family planning services for beneficiaries younger than 21 in the Child Health Services (EPSDT) Program. Federally Qualified Health Center (FQHC) Services FQHCs are also known as community health centers. Medicaid covers services in FQHCs that are not covered in doctors' offices and other clinics. A beneficiary may choose an FQHC as primary care physician (PCP). For FQHC physician services beyond the annual benefit limit, the provider must request an extension of benefits. The benefit limit does not apply to beneficiaries younger than 21 in the Child Health Services (EPSDT) Program. Home Health Services Eligible beneficiaries may receive home health services, which are similar to the services that...