Are the rules for Medicaid different in each state?
Yes, the Medicaid rules vary from state to state. Designed to provide coverage for economically disadvantaged populations across America, Medicaid rules vary based on the population of each state. Federal law sets broad requirements for Medicaid and mandates coverage of some populations and benefits, while leaving others optional. Each state has the flexibility to improve, modernize and update their Medicaid program by choosing:
- Who is eligible for enrollment
- Which services are covered
- How payments to providers are established
It is often said that variability in Medicaid is the rule rather than the exception. States establish their own eligibility standards, benefit packages, provider payment policies, and administrative structures under broad federal guidelines, effectively creating 56 different Medicaid programs—one for each state, territory, and the District of Columbia.
These are established through each state plan, a comprehensive document that must be approved by the Centers for Medicare & Medicaid Services. The document can be amended as needed to reflect changes in state policy, federal law, and regulation.