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State's Responsibility When Providing Medicaid

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Anytime a State decides to take part in Medicaid, they must be aware that there is a minimum set of benefits that they should offer for certain groups. They also have the choice to cover additional services and receive federal funds for the cost of those benefits. Nevertheless, the states count on flexibility to design their own benefits package and they will always vary from one state to another.

Among the basic services that must be included within all the packages offered, Medicaid beneficiaries are entitled to receive: nursing home care, hospital care (in as well as outpatients), physician services, x-ray and lab services, family planning services, periodic screening, treatments for children, family planning services, health center and rural health clinic services and nurse midwife and nurse practitioner services.

As said before, the states also have the choice to offer additional services and receive federal matching funds for those services. Within this modality, different kind of attentions can be provided such as prescription drugs, dental care and vision care, institutional care for mentally retarded individuals, personal care for individuals with disabilities, home and community care for elders.

The states manage their own policies of discretion surrounding the amount, duration and scope of the services that they give. Nevertheless, the one thing that must prevail always is that services must be “sufficient in amount, duration, and scope to reasonably achieve its purpose.” This means that the state is not entitled to limit the time coverage of the services provided by Medicaid. Moreover, the states must never condition the services based on the diagnosis or illness of the individual. For example, AIDS patients cannot be excluded from the services under any circumstance and the same goes for elders. AIDS patients and elders are two of the groups who use Medicaid more often.

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