However, comprehensive programs of health education, screenings, monitoring and medications are rarely available to Medicaid recipients in FFS Medicaid. Rather, they tend to get episodic care, which all too often result in death and disability. Inflexible Medicaid Benefits Coverage. States place limitations on Medicaid benefits as a way to control program costs. Many states, for example, will not pay for skilled nursing care for adults, because federal law makes it an optional benefit.
States often limit the number, dollar amount, or selection of services within a covered benefit.
For some high cost services, states have prior authorization systems which make it difficult to get a service as soon as it is needed. As a general rule, these limits are cost effective. In individual cases, they often end up costing more and doing less good than a more flexible approach to benefit coverage can provide. However, states are constricted by federal requirements to make the same benefits available to all Medicaid recipients. Providing a Medical Home.