The Medicaid program is a federal and state funded program that serves needy individuals and families who meet financial and other eligibility requirements and certain other individuals who lack adequate resources to pay for medical care.  The Division of Family Assistance determines financial eligibility and categorical eligibility and Medicaid Administration determines medical eligibility when it is required.  The Division for Children, Youth and Families and the Division of Community Based Care Services are responsible for the day-to-day operation of some Medicaid funded services and programs.

The program provides payment for medical services ranging from routine preventive medical care for children to institutional care for the elderly and disabled.  The Medicaid program also ensures access to care through enrollment of medical providers and access to transportation services to medical care providers through reimbursement to recipients and volunteer drivers.

Some of the specific medical services covered by the Medicaid program include hospital, physician, nursing facility, home health, lab, x-ray, family planning, rural health clinics, prescription drugs, physical-occupational-speech therapy, adult medical day care, medical transportation, medical supplies, durable medical equipment, dental, chiropractor, psychotherapy, podiatry, interpreter, advanced registered nurse practitioners, certified midwife, private duty nursing, EPSDT (early, periodic, screening and diagnostic testing), newborn home visits, extended services to pregnant women, personal care attendant, vision care, audiology, nursing facility, home and community based care for the elderly.  The program also covers services for developmentally disabled individuals and persons with acquired brain disorders, as well as services at community mental health centers.

In addition to determining medical eligibility, Medicaid Administration is responsible for ensuring that other sources of third party payment are used to cover health care costs and that health insurance premiums are paid for individuals who have access to other health insurance and when it is cost effective to do so. The unit is responsible for making decisions regarding the type and scope of medical care to be covered by the Medicaid program, keeping in mind access, quality, choice and cost effectiveness.

This unit also manages a prior authorization process for durable medical equipment, pharmaceuticals, service limit override requests and non-covered services that may be coverable under the medical necessity provisions of the EPSDT Program.