Scope of State Children's Health Insurance Benefits
Mandatory Benefits
- Inpatient hospital services
- Outpatient hospital services
- Physician services
- Surgical services
- Laboratory and radiological services
Optional Benefits
- Clinic services (including health center services) and other ambulatory health care services
- Prescription drugs
- Over-the-counter medications
- Prenatal care and prepregnancy family planning services and supplies
- Inpatient mental health services
- Durable medical equipment and other medically related or remedial devices (such as prosthetic devices and implants)
- Disposable medical supplies
- Home and community-based health care services and related supportive services
- Nursing care services
- Abortion only if necessary to save the life of the mother or if the pregnancy is the result of rape or incest
- Dental services
- Inpatient substance abuse treatment services and residential substance abuse treatment services
- Outpatient substance abuse treatment services
- Case management services
- Care coordination services
- Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders
- Hospice care
- Any other medical, diagnostic, screening, preventinve, restorative, remedial, therapeutic, or rehabilitative services if provided by a physician or other licensed or registered practitioner within the scope of practice, performed under the general supervision or at the direction of a physician, or offered by a licnesed or state-operated health care facility
- Premiums for private health care insurance coverage
- Medical transportation
- Enabling services (e.g., transportation, translation, outreach)
- Any other health care services or items specified by the Secretary of Health and Human Services and not excluded under 42 C.F.R. § 457/1/
1 42 U.S.C. § 1397jj(a) (Supp. 2001); 42 C.F.R. § 457.402 (2002).
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