C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 440—SERVICES: GENERAL PROVISIONS › Subpart B—Requirements and Limits Applicable to All Services

42 C.F.R. § 440.210

Required services for the categorically needy

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(a) A State plan must specify that, at a minimum, categorically needy beneficiaries are furnished the following services:

(1) The services defined in §§ 440.10 through 440.50, 440.70, and (to the extent nurse-midwives and nurse practitioners are authorized to practice under State law or regulation) the services defined in §§ 440.165 and 440.166, respectively.

(2) Pregnancy-related services and services for other conditions that might complicate the pregnancy.

(i) Pregnancy-related services are those services that are necessary for the health of the pregnant woman and fetus, or that have become necessary as a result of the woman having been pregnant. These include, but are not limited to, prenatal care, delivery, postpartum care, and family planning services.

(ii) Services for other conditions that might complicate the pregnancy include those for diagnoses, illnesses, or medical conditions which might threaten the carrying of the fetus to full term or the safe delivery of the fetus; and

(3) For women who, while pregnant, applied for, were eligible for, and received Medicaid services under the plan, all services under the plan that are pregnancy-related for an extended postpartum period. The postpartum period begins on the last day of pregnancy and extends through the end of the month in which the 60-day period following termination of pregnancy ends.

(b) A State plan must specify that eligible aliens as defined in §§ 435.406(a) and 436.406(a) of this subchapter will receive at least the services provided in paragraph (a) of this section.

(c) A State plan must specify that aliens not defined in §§ 435.406(a) and 436.406(a) of this subchapter will only be provided the limited services specified in § 440.255.

[56 FR 24010, May 28, 1991, as amended at 60 FR 19862, Apr. 21, 1995]
Notes of Decisions
Cited in 45 cases (6 in the last 5 years), 1980–2026 · leading case: Dobbs v. Jackson Women's Health Organization
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Dobbs v. Jackson Women's Health Organization (2022) scotus “42 CFR §§440.210 (a)(2)(i)–(ii) (2020). State Medicaid plans are also prohibited from imposing deduc- tions, cost-sharing, or similar charges for pregnancy-related services for pregnant women.”
M.R. v. Dreyfus (2011) ca9 · cites it 2× “§§ 1396a(a)(10)(A), 1396d(a)(1)-(5), (17), (21); 42 C.F.R. §§ 440.210 , 440.220. Within this federal framework, however, states retain “substantial discretion to choose the proper mix of amount, scope, and duration limitations on cov- erage.”
People v. Kanaan (2008) michctapp “We note that 42 USC 1396b(q)(3) speaks of prosecutions relative to Medicaid assistance provided pursuant to “the State plan under this subchapter.” Dental services for adults are an optional coverage under Medicaid and, as a result, states are not obligated to provide such…”
Levi Townsend v. Lyle Quasim, Secretary of the State of Washington Department of Social and Health Services (Dshs) (2003) ca9 · cites it 2× “225 (recognizing that the provision of services other than those listed in 42 C.F.R. §§ 440.210 and 440.220 is optional); Skandalis, 14 F.”
Henry Pashby v. Albert Delia (2013) ca4 “While states participating in Medicaid must provide coverage for certain services, such as prenatal care for qualifying pregnant women, 42 C.F.R. § 440.210 (a)(2), states may choose not to provide coverage for other services, such as PCS, see 42 C.”
M.R. v. Dreyfus (2011) ca9 · cites it 2× “§§ 1396a(a)(10)(A), 1396d(a)(1)-(5), (17), (21); 42 C.F.R. §§ 440.210 , 440.220. Within this federal framework, however, states retain “substantial discretion to choose the proper mix of amount, scope, and duration limitations on coverage.”
Fisher v. Oklahoma Health Care Authority (2003) ca10 “§ 1396a(10)(A)(i); 42 C.F.R. §§ 440.210 , .220. Mandatory services include nursing home care.”
Goldstar Medical Services, Inc. v. Department of Social Services (2008) conn “Federal medicaid regulations mandate that certain specified health services must be covered by a state plan; see 42 C.F.R. §§ 440.210 and 440.220; and allow states the option of covering other types of services.”
Cruz v. Zucker (2015) nysd · cites it 2× “§ 1396a(a)(10)(A) and its implementing regulation, 42 C.F.R. § 440.210 (the “Availability Requirement” of the Medicaid Act); (II) violation of 42 U.”
Maxwell Kadel v. Dale Folwell (2024) ca4 “42 C.F.R. § 440.210 10 Medicaid distinguishes between “categorically needy” and “medically needy” populations.”
John Smith v. Jessie K. Rasmussen, in Her Official Capacity as Director of the Iowa Department of Human Services (2001) ca8 “Smith cites the regulation broadly, but we note that, by its own terms, it applies solely to 42 C.F.R. §§ 440.210 and 440.220, which list required services for the classifications of categorically needy and medically needy, respectively.”
Cowan v. Myers (1986) calctapp · cites it 2× “Once the state determines to provide a certain type of service, for example X-ray services or dental services, the state must ensure there are adequate resources to achieve the purpose of the service.”
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