Medicaid Benefits: Clinic Services (Excluding Mandatory FQHC and RHC Services)

2018

Location	Benefit Covered	Copayment Required?	Limits on Services
United States	Yes - 42 No - 2 NR - 7	Yes - 25	Yes - 13
Alabama	No
Alaska	Yes	$3	No
Arizona	Yes	No	Screening services limited to no more than once every six months
Arkansas	NR	NR	NR
California	Yes	$1/visit	No
Colorado	Yes	$2 per visit	No
Connecticut	Yes	No	One medical clinic visit or treatment session per day per type of service; one complete rehabilitation evaluation per year per treatment modality
Delaware	Yes	No	No
District of Columbia	Yes	No	Some procedures require a PA
Florida	Yes	Hospital outpatient department or clinic visit for elective or scheduled admissions, $3 per day	No
Georgia	Yes	$3 copay	Must be medically necessary.
Hawaii	Yes	No	No
Idaho	Yes	No	No
Illinois	NR	NR	NR
Indiana	No
Iowa	NR	NR	NR
Kansas	Yes	$2.00 per service date	No
Kentucky	Yes	$3	No
Louisiana	Yes	No	NR
Maine	Yes	$.50 to $2/day depending on payment amount, up to $20/month	Yes - Not Specified
Maryland	Yes	No	No
Massachusetts	Yes	No	No
Michigan	Yes	$1/visit	No
Minnesota	Yes	$3 copay for non-preventive office visits	No
Mississippi	Yes	$3 per visit	NR
Missouri	Yes	$0.50	There are daily quantity limits on services.
Montana	Yes	Income at or below 100% FPL - $4 per visit; above FPL - 10% of payment amount	No
Nebraska	Yes	No	No
Nevada	NR	NR	NR
New Hampshire	NR	NR	NR
New Jersey	Yes	No	No
New Mexico	Yes	$7 for WDI recipients	No
New York	NR	NR	NR
North Carolina	Yes	$1 - $3 depending on the service	NR
North Dakota	Yes	$2 per visit	No
Ohio	Yes	If the clinic offers dental services, some services have a $3 co-pay; If the clinic offers vision services, some services have a $2 copay and there is a $1 co-pay for eyeglasses; If the clinic has an on-site pharmacy, co-pay amounts range from $0-$3.	Limits for dental, vision, psychology, audiology, and OT/PT services rendered at a clinic are shown below. If the clinic holds a DME contract, there are also DME limitations (shown below).
Oklahoma	Yes	$4 per visit	Clinic services are limited to the same scope of services that are otherwise furnished in the plan, as appropriate.
Oregon	Yes	No	Coverage is based upon Oregon's 1115 waiver and Health Evidence Review Commission's prioritized list of health services
Pennsylvania	Yes	Sliding scale based on the Medicaid fee for the service: $0.65 - $3.80	No
Rhode Island	Yes	No	No
South Carolina	NR	NR	NR
South Dakota	Yes	$/visit	No
Tennessee	Yes	No	No
Texas	Yes	No	No
Utah	Yes	$4 per visit	No
Vermont	Yes	No	5 office visits per month; 1 acute care hospital visit per day; 1 nursing facility visit per week; prior authorization required for certain services and to exceed stated visit limits
Virginia	Yes	$1 per visit	NR
Washington	Yes	No	PA may be required if the service being delivered in this setting requires PA
West Virginia	Yes	Office visits are $2 for those 50-100% FPL and $4 for those 100% FPL and above	No
Wisconsin	Yes	ESRD, if no dialysis provided there is a $3.00 per date of service; ASC, $3.00 copayment for each procedure over $50; no copayment for the professional service	A small number of services require prior approval.
Wyoming	Yes	$2.45 for non - emergent	Prior authorization is required after the first 12 visits to confirm ongoing medical necessity

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Medicaid Benefits: Clinic Services (Excluding Mandatory FQHC and RHC Services)

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Medicaid Benefits: Clinic Services (Excluding Mandatory FQHC and RHC Services)

2018

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