Non-Covered Services

The items or services listed below are generally not covered by the Medicaid program. Some exceptions do apply; however, the item or service must be medically necessary and ordered by a physician before the exception can be applied.

• Items or services which have been determined by the DHS Medical, Optometric or Dental consultant or the peer review organization to not be medically necessary
• Items or services provided by immediate relatives or members of the recipient's household
• Over-the-counter drugs, home remedies, food supplements, nutritional items, vitamins, or alcoholic beverages except for certain items which are prescribed by a doctor
• Broken or missed appointments
• Medical equipment and supplies for an individual in a nursing facility, swing bed or ICF/MR
• Custodial care
• Services for individuals over 21 and under 65 in the state hospital, a public institution or an institution for mental disease
• Health services which are not documented in the recipient's medical record
• Services, procedures, or drugs which are considered experimental by the US Department of Health and Human Services or another federal agency
• Drugs and biologicals which the federal government has determined to be less than effective (Desi drugs)
• Cosmetic surgery to improve the appearance of an individual when not incidental to repairs following an accidental injury or any cosmetic surgery which goes beyond what is necessary for the improvement of functioning of malformed body members
• Acupuncture
• Organ transplants which are not prior approved
• Procedures for implanting an embryo
• Procedures and services to reverse sterilization
• Autopsies
• Reports required solely for insurance or legal purposes
• Record keeping, charting or documentation related to providing a covered service
• Vocational training, educations activities, teaching, or counseling
• Self-help devices, exercise equipment, protective outerwear, personal comfort items or services, and environmental control equipment
• Computers, computer hookups, or printers except for assistive communication devices
• Payment to hold a bed in a nursing facility, swing bed or ICF/MR unless specifically provided for by the department
• Payment for a private room in a nursing facility or basic care facility

 

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