Children's Health Insurance Expansions: State Experiences in Developing Benefit Packages and Cost-Sharing Arrangements. Children's Benefit Packages Under Medicaid


States electing to expand children's health insurance through the Medicaid option will be required to offer the traditional comprehensive Medicaid benefit package which includes: inpatient and outpatient hospital services; physician services; medical and surgical dental services; family planning services and supplies; laboratory and x-ray services; and pharmaceuticals. There are specific requirements as to the duration and scope of these benefits.

States must also provide well-child visits; immunizations; sick care; outpatient care; inpatient care; emergency room use; prescriptions; and Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT) services for individuals under age 21. This benefit requires that Medicaid beneficiaries under 21 are must receive screening, vision, hearing, and dental services at intervals which meet recognized standards of medical and dental practices, and at other intervals as necessary to determine the existence of physical or mental illnesses or conditions. Any service that is necessary to treat an illness or condition identified by a screen must be provided to EPSDT participants. In addition, states may add certain optional services such as: emergency hospital services; intermediate care facility/mentally retarded (ICF/MR services; optometrist services and eyeglasses; prescription drugs; TB-related services; prosthetic devices; and dental services (nonmedical or surgical).