Long-Term Services that Medicaid Covers
There are some long-term services that Medicaid programs are required to cover, and states have the option of covering additional services through Medicaid. All states cover some optional services.
To receive long-term services, someone in Medicaid must also meet the clinical/functional eligibility requirements for those services, such as needing help with certain daily activities. States set those requirements.
Long-term care services fall into two categories: 1) institutional services, such as care that is provided in nursing homes and residential treatment facilities, and 2) non-institutional or home- and community-based services (HCBS). Home- and community-based services are services that are provided at home or in a community setting, such as a group home or residential care facility. These services include home health and personal care services, as well as supports that allow people to remain in the community, such as specialized medical equipment and supplies, non-medical transportation, adult day care services, and respite for caregivers.
Within broad federal guidelines about service requirements, states determine the amount and duration of services they will offer, such as the number of home health visits they will be cover. The law does require that services be offered in sufficient amount, duration, and scope to reasonably accomplish their goals. Generally, states are required to provide comparable services to all people who fall into one of the mandatory eligibility categories.
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Medicaid and Long-Term Services Home | Medicaid Eligibility and Long-Term Services | Ways that States Can Provide Long-Term Services | Challenges, Opportunities, and Advocacy
