• Other diagnostic, screening, preventive, and rehabilitative services, including medical or remedial services recommended for the maximum reduction of physical or mental disability and restoration of an individual to the best possible functional level (in a facility, home, or other setting)

  • Services in an intermediate care facility for the mentally retarded

  • Inpatient psychiatric hospital services for individuals under age 21

  • Services furnished by a midwife, which the nurse-midwife is legally authorized to perform under state law, without regard to whether or not the services are performed in the area of management of the care of mothers and babies throughout the maternity cycle

  • Hospice care

  • Case management services

  • Tuberculosis-related services

  • Respiratory care services

  • Services furnished by a certified pediatric nurse practitioner or certified family nurse practitioner that the practitioner is legally authorized to perform under state law

  • Community-supported living arrangement services (e.g., personal assistance, habilitation services, assistive technology), to the extent allowed and defined in 42 U.S.C. §1396u

  • Personal care services (in a home or other location) furnished to an individual who is not an inpatient or resident of a hospital, nursing facility, intermediate care facility for the mentally retarded, or institution for mental disease

  • Primary care case management services

  • Any other medical care, and any other type of remedial care recognized under state law, specified by the secretary (includes transportation and personal care services in a recipient’s home)

SOURCE: Perkins, 1999.

children and families. Eligibility for services provided under this demonstration waiver authority is not restricted to low-income families. A condition for both Section 1915(c) and Section 1115 waivers is that they be budget neutral (i.e., not generate costs to the federal government more than occur without the waiver).

As discussed in a later section on professional and provider payment, Medicaid coverage for specific services is less an issue for many physicians, hospitals, and Medicaid enrollees than is the level and predictability of payments. A significant fraction of physicians do not accept Medicaid patients because payment levels are low and claims administration can be frustratingly inconsistent (Yudowsky et al., 2000; see also AAP, 1999d). This can result in access problems for children covered by Medicaid.



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