COD E R E D

• Institutionalized individuals with income and resources below specified limits.• People who would be eligible if institutionalized but who are receiving care under homeand community-based services waivers.• Recipients of state supplementary payments• People with tuberculosis (TB) who would be financially eligible for Medicaid at the SSIlevel (only for TB-related ambulatory services and TB drugs).• Low-income, uninsured women screened and diagnosed through a Centers for DiseaseControl and Prevention Breast and Cervical Cancer Early Detection Program anddetermined to be in need of treatment for breast or cervical cancer. 11States may also receive matching funds for an optional “medically needy” program to extendMedicaid coverage to additional people who have too much income or resources to qualifyunder the mandatory or optional categorically needy groups. This program allows people tospend down to Medicaid eligibility by having their medical expenses offset their excess income,and may also allow them to pay monthly premiums to the state for Medicaid. If a state choosesto have a medically needy program, it must include certain children under age 18, pregnantwomen through a 60-day postpartum period, certain newborns for one year, and certain blindpeople. The state may choose to provide coverage for additional medically needy people suchas the aged, blind, disabled (including disabled people who work), people 21 and under who arefull-time students, and relatives who live with and are caretakers of children without parentalsupport. As of 2003, 37 states had medically needy programs within Medicaid. 12Some states also expand their eligibility requirements through Medicaid waivers (discussed inmore detail below). As of 2003, there were 19 states with statewide 1115 waivers to expandeligibility, and these usually require that the beneficiaries enroll in a Medicaid managed careprogram in order to receive services. 13 These extra “waiver populations” may include peoplesuch as childless adults, low-income women needing family planning services, or HIV-positivepeople who are not yet disabled enough to qualify for regular Medicaid. 14Mandatory and Optional Medicaid BenefitsIn order to receive matching funds, a state’s Medicaid program must follow federal guidelinesrequiring that certain basic services be offered to the covered groups. The mandatory benefitsinclude the following:• Inpatient and outpatient hospital services;• Prenatal care;• Vaccines for children;• Physician services;• Nursing facility services for people aged 21 or older;• Family planning services and supplies;• Rural health clinic services;• Home health care for people eligible for skilled-nursing services;• Laboratory and x-ray services;• Pediatric and family nurse practitioner services;B-5