How Does Medicaid Differ for Adults?

Medicaid benefits and services differ for adults.  

The definition of “adult” varies by program.  Eligibility programs and waiver programs can change eligibility at ages 16, 18 or 19.   

Medicaid benefits for adults do not include coverage for:

• eyewear
• hearing aids
• or habilitative therapies

In addition, Medicaid will only cover the purchase of a wheelchair once every five years.

There are other limits to adult benefits.  For example, with therapies, the adult needs to be making gains in order for those therapies to continue to be covered.

The Early & Periodic Screening, Diagnostic & Treatment Program (EPSDT) no longer applies to those who are 21 years of age. These benefits end on a person’s 21st birthday, rather than at the end of the month.  Please be sure to order any needed items or services, such as hearing aids or glasses, prior to the 21st birthday.

Please contact your local county department of human services with any questions regarding eligibility ages or programs.

Please also check, when a child moves from children’s to adult Medicaid, to ensure that the same services, at the same level. will continue.

To summarize: Medicaid for adults covers a variety of medical services.  However, coverage varies based on a various factors, including whether a given provider accepts Medicaid.  Be sure to check out Medicaid’s service provisions on the Health Care Policy and Financing website.