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(1) Except as otherwise provided in this rule, the following medical or remedial care and services are available to all persons who are eligible for Medicaid benefits under this chapter including deceased persons, categorically related, who would have been eligible had death not prevented them from applying.

(a) inpatient hospital services;

(b) outpatient hospital services;

(c) non-hospital laboratory and x-ray services;

(d) nursing facility services;

(e) early and periodic screening, diagnosis and treatment services;

(f) physician's services;

(g) podiatry services;

(h) outpatient physical therapy services;

(i) speech therapy, audiology and hearing aid services;

(j) outpatient occupational therapy services;

(k) home health care services;

(l) personal care services in a member's home;

(m) home dialysis services;

(n) private duty nursing services;

(o) clinic services;

(p) dental services;

(q) outpatient drugs;

(r) durable medical equipment, prosthetic devices, and medical supplies;

(s) eyeglasses and optometric services;

(t) transportation and per diem;

(u) ambulance services;

(v) specialized nonemergency transportation;

(w) family planning services;

(x) home and community services;

(y) mid-level practitioner services;

(z) hospice services;

(aa) licensed psychologist services;

(ab) licensed clinical social worker services;

(ac) licensed professional counselor services;

(ad) inpatient psychiatric services;

(ae) mental health center services;

(af) case management services;

(ag) institutions for mental diseases for persons age 65 and over;

(ah) payment of premiums, co-insurance, deductibles, and other cost sharing obligations under an individual or group health plan in accordance with the provisions of ARM 37.82.424;

(ai) diabetes and cardiovascular disease prevention services;

(aj) habilitative services; and

(ak) rehabilitative services.

(2) Only those medical or remedial care and services also covered by Medicare are available to a person who is eligible for Medicaid benefits as a qualified Medicare beneficiary under ARM 37.83.201 and 37.83.202.

(3) State plan Medicaid benefits are available for members who are Medicaid-covered through the Waiver for Additional Services and Populations (WASP) Medicaid 1115 Waiver as approved by the Centers for Medicare and Medicaid Services (CMS).

(a) A person may receive coverage through the WASP Medicaid 1115 Waiver if the person is 18 or older, has severe disabling mental illnesses (SDMI), would qualify for or be enrolled in the state-financed mental health services plan (MHSP) or the WASP Medicaid 1115 Waiver but is otherwise ineligible for Medicaid benefits, and either:

(i) the person's income is 0 to 138% of the federal poverty level and the person is eligible for or is enrolled in Medicare; or

(ii) the person's income is 139 to 150% of the federal poverty level whether Medicare eligible or not.

(b) A person determined categorically eligible for Medicaid as aged, blind, or disabled (ABD) in accordance with ARM 37.82.901 through 37.82.903 is not subject to the annual $1,125 dental treatment limit. The monies expended for treatment costs exceeding the limit are covered through the WASP Medicaid 1115 Waiver.

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-103, 53-6-111, 53-6-113, 53-6-131, 53-6-141, MCA; NEW, 1980 MAR p. 1789, Eff. 6/27/80; AMD, 1986 MAR p. 677, Eff. 4/25/86; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1987 MAR p. 1688, Eff. 10/1/87; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1988 MAR p. 2228, Eff. 10/14/88; AMD, 1989 MAR p. 835, Eff. 6/30/89; AMD, 1989 MAR p. 842, Eff. 7/1/89; AMD, 1991 MAR p. 1021, Eff. 6/28/91; AMD, 1992 MAR p. 1401, Eff. 6/26/92; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1997 MAR p. 474, Eff. 3/11/97; AMD, 1997 MAR p. 898, Eff. 3/25/97; AMD, 1999 MAR p. 1806, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 479; AMD, 2009 MAR p. 2379, Eff. 1/1/10; AMD, 2012 MAR p. 1671, Eff. 8/24/12; AMD, 2016 MAR p. 829, Eff. 5/7/16.

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