Optional Medicaid Benefit for Tuberculosis (TB)-Related Services

Background

The Omnibus Budget Reconciliation Act of 1993 (OBRA ’93), amended the Social Security Act (the Act) to allow states, at their option, to extend Medicaid eligibility to low-income individuals infected with TB, while limiting eligibility to TB-related services.

Prior to OBRA ’93, TB-infected individuals who did not qualify as disabled under the disability definition used in the Supplemental Security Income (SSI) program would have been unlikely to receive Medicaid coverage.  Even though these individuals might have met the income and resource requirements of the cash assistance programs, they could not meet the categorical requirements necessary to qualify for Medicaid.

The statutory text following Section 1902(a)(10)(F) of the Act was amended to provide for an exception to the comparability rules, which require certain types of eligibility groups to be treated comparably in terms of the services available.  The exception provides that coverage for individuals who are eligible for Medicaid under the optional TB-infected eligibility group is limited to the TB-related services listed in Section 1902(z) (2).

Section 13603 of OBRA ’93 added a new Section 1902(z) (2) that specifies the categories of services that eligible TB-infected individuals may receive.

Coverage of Services

Services available to persons who are eligible on the basis of being TB-infected are limited to those listed in section 1902(z) (2).  They include the following: 

• Prescribed drugs;
• Physicians’ services and services described in section 1905(a)(2) of the act (includes outpatient hospital services, rural health clinic services, and Federally qualified health center services);
• Laboratory and X-ray services (including those to confirm the presence of infection);
• Clinic services and Federally qualified health center services;
• Case management services (as defined in section 1915(g)(2)); and
• Services (other than room and board) designed to encourage completion of regimens of prescribed drugs by outpatients, including services to directly observe the intake of prescribed drugs.

Although Section 1902(z)(2) lists these services as available to the new eligibility group, the services (except for case management and services designed to encourage the completion of TB drug regimens) are available only to the extent they are otherwise available to mandatory categorically needy eligibility groups under the State’s Medicaid plan.

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Page Last Modified: 07/29/2005 1:48:00 PM
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