Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals 001 = Inpatient Hospital Services 002 = Outpatient Hospital Services 003 = Rural health clinic services 004 = FQHC services 005 = Other Laboratory and X-Ray Services 006 = Nursing Facility Services for 21 and over 007 = EPSDT 008 = Family Planning Services 009 = Mandatory tobacco cessation counseling for pregnant women under 1905(a)(4)(D) 010 = Physicians' Services 011 = Medical and Surgical Services Furnished by a Dentist 012 = Nurse-midwife services 013 = Certified pediatric or family nurse practitioners' services 014 = Free Standing Birth Center Services 015 = Home Health Services — Intermittent or part-time nursing services provided by a home health agency 016 = Home Health Services — Home Health Aide Services Provided by a Home Health Agency 017 = Home Health Services — Medical supplies, equipment, and appliances suitable for use in the home Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals 018 = Medical care and any type of remedial care recognized under state law — Podiatrists' Services 019 = Medical care and any type of remedial care recognized under state law — Optometrists' Services 020 = Medical care and any type of remedial care recognized under state law — Chiropractors' Services 021 = Medical care and any type of remedial care recognized under State law — Other Practitioners' Services within scope of practice as defined by state law 022 = Home Health Services — Physical therapy; occupational therapy; speech pathology; audiology provided by a home health agency 023 = Private Duty Nursing 024 = Clinic Services 025 = Dental Services 026 = Physical Therapy and Related Services — Physical Therapy 027 = Physical Therapy and Related Services — Occupational Therapy 028 = Physical Therapy and Related Services — Services for individuals with speech, hearing and language disorders 029 = Prescription drugs, dentures, and prosthetic devices; and eyeglasses — Prescribed Drugs 030 = Prescription drugs, dentures, and prosthetic devices; and eyeglasses — Dentures 031 = Prescription drugs, dentures, and prosthetic devices; and eyeglasses — Prosthetic Devices 032 = Prescription drugs, dentures, and prosthetic devices; and eyeglasses — Eyeglasses 033 = Other diagnostic, screening, preventive, and rehabilitative services — Diagnostic Services 034 = Other diagnostic, screening, preventive, and rehabilitative services — Screening Services 035 = Other diagnostic, screening, preventive, and rehabilitative services — Preventive Services 036 = Other diagnostic, screening, preventive, and rehabilitative services — Rehabilitative Services 037 = Services for individuals over age 65 in IMDs — Inpatient hospital services 038 = Services for individuals over age 65 in IMDs — Nursing facility services 039 = Intermediate Care Facility Services for individuals with intellectual disabilities or persons with related conditions 040 = Inpatient psychiatric facility services for under 21 041 = Hospice Care 042 = Case Management Services and TB related services — Case management services as defined in the State Plan in accordance with section 1905(a)(19) or 1915(g) 043 = Case Management Services and TB related services — Special TB related services under section 1902(z)(2) 044 = Respiratory care services under 1902(e)9)(A) through (C) 045 = Personal care services 046 = Primary care case management services 047 = Special sickle-cell anemia-related services 048 = Any other medical care and any other type of remedial care recognized under state law, specified by the Secretary — Transportation 049 = Any other medical care and any other type of remedial care recognized under state law, specified by the Secretary — Services provided in religious non-medical health care facilities 050 = Any other medical care and any other type of remedial care recognized under state law, specified by the Secretary — Nursing facility services for patients under 21 051 = Any other medical care and any other type of remedial care recognized under state law, specified by the Secretary — Emergency hospital services 052 = Any other medical care and any other type of remedial care recognized under state law, specified by the Secretary — Critical Access Hospitals 053 = Extended services for pregnant women — Additional Services for any other medical conditions that may complicate pregnancy 054 = Community First Choice 055 = Health Home Services Special Benefit Provisions 056 = Limited Pregnancy-Related Services for Pregnant Women with Income Above the Applicable Income Limit 057 = Ambulatory prenatal care for pregnant women furnished during a presumptive eligibility period 058 = Benefits for Families Receiving Transitional Medical Assistance 059 = Standards for Coverage of Transplant Services 060 = School-Based Services Payment Methodologies 061 = Indian Health Services and Tribal Health Facilities 062 = Methods and Standards to Assure High Quality Care Coordination of Medicaid with Medicare and Other Insurance 063 = Medicare Premium Payments 064 = Medicare Coinsurance and Deductibles 065 = Other Medical Insurance Premium Payments Special Benefit Programs 066 = Programs for Distribution of Pediatric Vaccines Home and Community-Based Services 067 = Laboratory and X-Ray services 068 = Home Health Services — Home health aide services provided by a home health agency 069 = Private duty nursing services 070 = Physical Therapy and Related Services — Audiology services 071 = Extended services for pregnant women — Additional Pregnancy-related and postpartum services for a 60-day period after the pregnancy ends and any remaining days in the month in which the 60th day falls. 072 = Home and Community Care for Functionally Disabled Elderly individuals as defined and described in the State Plan 073 = Emergency services for certain legalized aliens and undocumented aliens 074 = Licensed or Otherwise State-Approved Free-Standing Birthing Center and other ambulatory services that are offered by a freestanding birth center 075 = Homemaker 076 = Home Health Aide 077 = Adult Day Health services 078 = Habilitation 079 = Habilitation: Residential Habilitation 080 = Habilitation: Supported Employment 081 = Habilitation: Education (non-IDEA available) 082 = Habilitation: Day Habilitation 083 = Habilitation: Pre-Vocational 084 = Habilitation: Other Habilitative Services 085 = Respite 086 = Day Treatment (mental health service) 087 = Psychosocial rehabilitation 088 = Environmental Modifications (Home Accessibility Adaptations) 089 = Vehicle Modifications 090 = Non-Medical Transportation 091 = Special Medical Equipment (minor assistive Devices) 092 = Home Delivered meals 093 = Assistive Technology (i.e., communication devices) 094 = Personal Emergency Response (PERS) 095 = Nursing Services 096 = Community Transition Services 097 = Adult Foster Care 098 = Day Supports (non-habilitative) 099 = Supported Employment 100 = Supported Living Arrangements 101 = Supports for Consumer Direction (Supports Facilitation) 102 = Participant Directed Goods and Services 103 = Senior Companion (Adult Companion Services) 104 = Assisted Living Other 105 = Program for All-inclusive Care for the Elderly (PACE) Services 106 = Self-directed Personal Assistance Services under 1915(j) 107 = In vitro diagnostic products for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products 108 = COVID–19 testing-related services Null/missing = source value is missing or unknown