Covered services

Covered services

All managed care entities (MCEs) offer the same basic benefits and services.  Some services may require prior authorization (pre-approval) or be medically necessary. You need to contact your MCE to verify if they cover the service you need and if you need prior authorization (pre-approval).

• Care conferences
• Chiropractic services
• Dental services
• Diabetes self-management training services
• Emergency services
• Eye care, eyeglasses, and vision services
• Family planning services and supplies
• Federally-qualified health centers (FQHCs)
• Food supplements and nutritional supplements
• Hospital services – inpatient
• Hospital services – outpatient
• Home health services
• Hospice care
• Immunizations
• Laboratory and radiology services
• Legend drugs
• Long term acute care hospitalization
• Medical supplies and equipment (including prosthetic devices, implants, hearing aids, dentures, etc.)
• Mental health / behavioral health services – inpatient
• Mental health / behavioral health services – outpatient
• Non-legend drugs
• Nurse practitioners
• Nursing facility services (long term)
• Nursing facility services (short term)
• Occupational therapy
• Organ transplants
• Orthodontics
• Out-of-state medical services
• Physician assistant
• Physicians' surgical and medical services
• Physical therapy
• Podiatrists
• Rehabilitative unit services – inpatient
• Residential substance use disorder (SUD) services
• Respiratory therapy
• Rural health clinics
• Smoking cessation and tobacco dependence treatment services
• Speech, hearing, and language disorder services
• Transportation – emergency
• Transportation – non-emergency medical
• Urgent care services

Home and community-based services (HCBS)

HCBS services for members who qualify:

• Adult day services
• Attendant care
• Caregiver coaching
• Home and community assistance
• Respite care
• Community home share assisted living
• Community transition services
• Home-delivered meals
• Home modification assessment
• Home modifications
• Integrated health care coordination
• Nutritional supplements
• Participant-directed attendant care
• Personal emergency response system (PERS)
• Pest control
• Specialized medical equipment and supplies
• Structured family caregiving
• Transportation
• Vehicle modifications