What Services Are Covered?

The following services are covered by Medicaid when the providers are contracted with Priority Health and the services are determined to be medically necessary and appropriate.  If you are 21 years of age or older, you may be responsible for Copayments (or Copay) for certain services.

• Inpatient and outpatient hospital services*
• Emergency services
• Primary Care Provider visits
• Certified pediatric or family nurse practitioner services
• Well child check-ups (up to age 21)
• Immunizations (shots)
• Blood lead follow-up (up to age 21)
• OB/GYN and Certified Nurse Midwife services
• Family planning
• Vision services  (you may be required to pay a $2 Copay per visit)
• Sexually transmitted disease treatment
• Maternal and Infant Support services
• Health Education*
• Specialty Provider visits*
• Chiropractic services*  (you may be required to pay a $1 Copay per visit)
• Podiatry services*  (you may be required to pay a $2 Copay per visit)
• Transplant services*
• Pharmacy services*  (you may be required to pay a $1 Copay per prescription for non family planning or non-pregnancy related medications. )
• Prosthetics and orthotics*
• Durable Medical Equipment and supplies*
• Hospice services*
• Transportation*
• Ambulance and other emergency medical transportation
• Hearing and speech services, including hearing aids*  (you may be required to pay a $3 Copay per hearing aid)
• Therapies (speech, language, physical and occupational)*
• Diagnostic lab, x-ray and other imaging services*
• Home Health services*
• Short term restorative or rehabilitative nursing care*
• Parenting and birthing classes*
• Medically necessary weight reduction services*
• End stage renal disease services*
• Mental Health care - up to 20 outpatient visits per year
• Out of state services (if authorized by plan)*

*  These services are covered when they are medically necessary and appropriate.  Except in a life-threatening emergency, these must be referred by your primary care doctor, and/or approved by Priority Health before you receive services.  There may be a limit to the number of visits approved based upon medical necessity.  The Certificate of Coverage (COC) describes these limitations in greater detail.  Your doctor will help you arrange these services or you may call the Priority Health Customer Service Department at 1 888 975-8102 if you have questions.