As more states have expanded Medicaid benefits, more people are eligible for this program than in the past. One result of this is that there are many people now covered by Medicaid that have never had coverage before. These newly insured people are still learning about the program and what it covers, and may be surprised to find that, in some cases, a seemingly straightforward procedure like a chiropractic adjustment isn’t covered and they will have to pay out-of-pocket.

Medicaid coverage in the United States can vary by state and region, and in some areas, there are other medical assistance organizations available. These organizations can help cover procedures that Medicaid doesn’t pay for. For example, in some areas, Medicaid doesn’t cover dental procedures for adults, but local community clinics often provide services on a sliding scale.

Here are some common items and services that Medicaid may not cover in your area:

Dental Services

There are limits on the dental care that Medicaid will pay for. In a few states, no dental procedures are covered for adults on Medicaid. However, in some states certain medically necessary procedures are allowed but they may have to be approved before the procedure is done. In other states, dental care is restricted by a dollar amount.

Before getting a procedure done, check with your local office or a well-educated dentist to find out if it will be covered. For example, if you are seeking dental implants Rock Hill SC, call a local dentist’s office or your Medicaid office before scheduling the treatment. If your procedure ends up not being accepted, you will be required to pay out of pocket.

Cosmetic Surgery

Cosmetic surgery is not usually covered by Medicaid. Because nearly all cosmetic surgery is elective, taxpayer money can’t be used to pay for it. In a few very rare cases, where it is medically necessary, the procedure may be covered. In these rare cases, pre-authorization would be required. Examples of cosmetic surgery that Medicaid may cover include reconstructive surgery, such as breast reconstruction after cancer, and skin removal after weight loss in cases where the excess skin is causing health problems.

Non-Prescription Drugs and Health Supplements

In many states, Medicaid won’t pay for non-prescription drugs, such as painkillers, over-the-counter allergy medicine, and cold remedies. These medicines are available for everyone to buy and aren’t covered under insurance programs. Similarly, supplements like vitamins, herbal remedies, homeopathic medicines, and OTC medicated creams cannot be purchased using Medicaid funds. These items are usually not covered by any medical insurance, so it is not abnormal that they are not covered by Medicaid, either.

Experimental Treatments

Treatments that aren’t FDA-approved usually can’t be covered under Medicaid. Because experimental or unproven treatments haven’t been safety-tested and haven’t been proven in studies, they can’t be paid for with tax-payer money. In some cases, these procedures are dangerous and shouldn’t be used. In others, they simply haven’t been proven to be effective, and are therefore potentially wasteful of government money.

Elective Abortions

In most cases, you cannot get an abortion and pay for it with Medicaid funds. This is the case for the majority of abortions, however, there are exceptions. Medically required abortions such as those in the case of a life-threatening problem with the pregnancy may be covered. This can happen in situations where the pregnancy has implanted outside of the uterus, called an ectopic pregnancy, and in cases where the mother cannot receive life-saving medication while pregnant, as is the case with some cancer treatments. If the pregnancy was the result of rape, an abortion can also be covered by Medicaid.

Personal Comfort Items

Items that are personal preferences, such as private rooms in a hospital or TV rentals, aren’t usually covered by Medicaid. Standard hospital rooms and equipment are considered sufficient and Medicaid won’t spend extra money on special situations. In some cases, if a doctor has deemed something medically necessary, it may be covered. In most of these special cases, the purchase will have to be pre-approved.

Home Modifications for Disability

Medicaid doesn’t typically pay for modifications to homes, such as handicap-accessible bathtubs, hospital beds, or wheelchair-accessibility features. However, there is a Medicaid waiver program that can help pay for these things when they are deemed medically necessary. The waiver program is designed to create an environment in the patient’s home that will allow them to stay at home in the care of family rather than be transferred into a nursing home or group home.

Non-Emergency Medical Transportation

You may or may not be able to get assistance with non-emergency transportation. Medicaid may not pay for your transportation, but if they do not, many states have reimbursements for required travel over a certain distance. Recipients may have to show that they couldn’t have done the procedure anywhere closer and they may have to keep mileage records. In other cases, state and local governments or local charities provide transportation for Medicaid recipients.

Necessary ambulance transportation, whether emergency or non-emergency, such as transportation between two hospitals, is always covered by Medicaid.

Alternative Treatments and Procedures

Alternative treatments that haven’t been proven in scientific studies usually aren’t covered by Medicaid. Some procedures, such as chiropractic treatments and acupuncture, are sometimes covered. These treatments are more likely to be covered if they are recommended or prescribed by a doctor. Other alternative treatments that are occasionally covered include massage, pain treatments, and nutrition therapy. Some treatments, such as herbal and homeopathic therapies, are usually not approved for Medicaid payment.

Conclusion

It is important to remember that Medicaid policies vary by state, so it’s best to check with your local Medicaid office to confirm what is and isn’t covered in your state. You won’t always know if something is covered unless you ask, and in some cases, waivers and exceptions can be granted if a doctor requests them.