Benefits Collaborative Approved Benefits Standards

The following Benefit Coverage Standards have completed the Benefits Collaborative Process, been approved by the State Medicaid Director, and are in effect.

Note: Not all services covered by Medicaid appear in the list below. This list represents those services that have been documented through the Benefits Collaborative Process.

BENEFIT COVERAGE STANDARD EFFECTIVE DATE REVIEW DATE
Abortion Services October 9, 2014 October 9, 2017
Ambulance Services April 2, 2012 April 2, 2015
Ambulatory Surgery Centers May 1, 2012 May 1, 2015
Augmentative and Alternative Communication Devices June 28, 2013 June 28, 2015
Bariatric Surgery August 1, 2012 August 1, 2015
Bone Mass Measurement May 3, 2010 May 2, 2013
Computed Tomography (CT) Scans October 18, 2013 October 18, 2016
Dental-Adult Dentures January 27, 2015 January 27, 2018
Dialysis Treatment Centers May 1, 2012 May 1, 2015
Disorders of Sex Development (DSD) and Intersex Surgical Remediation August 1, 2012 August 1, 2015
DME Oxygen September 1, 2011 September 1, 2014
Echocardiogram December 22, 2014 December 22. 2017
Family Planning November 19, 2014 November 19, 2017
General Radiography (X-ray) October 18, 2013 October 18, 2016
Home Health Services January 1, 2012 December 31, 2015
Hospice Services June 1, 2012 June 1, 2015
Immunization Services April 2, 2012 April 2, 2015
Magnetic Resonance Imaging (MRI) October 18, 2013 October 18, 2016
Maternity Services February 23, 2015 February 23, 2018
Non-Emergent Medical Transportation Services September 10, 2014 September 10, 2017
Podiatry Services May 1, 2012 May 1, 2015
School-Based Health Centers August 1, 2012 August 1, 2015
Speech - Language and Hearing Services July 2, 2012 July 2, 2015
Substance Use Disorder (Fee-for-Service) April 8, 2015 April 8, 2018
Women's Health Services February 3, 2015 February 3, 2018