Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

Practitioner Services

Prescription Drugs

Physical Therapy and Other Services

Products and Devices

Transportation Services

Other Services

Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: Guam (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes			Limited to services unavailable at Guam Memorial Hospital	Fee for service	CN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes				Fee for service	CN
Federally Qualified Health Center Services
No
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes			LOS limited to 60 days	Negotiated rate/service	CN
Outpatient Hospital Services
Yes		Non-emergency therapy services, CT-scans		Negotiated rate/service	CN
Rehabilitation Services: Mental Health and Substance Abuse
No
Rural Health Clinic Services
No
Practitioner Services
Certified Registered Nurse Anesthetist Services
No
Chiropractor Services
No
Dental Services
Yes			Limited to trauma care, treatment required due to medical conditions, and emergency treatment for relief of pain and infection	Fee for service	CN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes			1 inpatient hospital visit/day	Fee for service	CN
Nurse Midwife Services
No
Nurse Practitioner Services
Yes				Fee for service	CN
Optometrist Services
Yes		Yes		Fee for service	CN
Physician Services
Yes			1 inpatient hospital visit/day, 20 psych visits/year, routine physical exams and acupuncture not covered	Fee for service	CN
Podiatrist Services
Yes			Routine foot care not covered	Fee for service	CN
Psychologist Services
Yes			20 service sessions/year	Fee for service	CN
Prescription Drugs
Prescription Drugs
Yes			Adult vitamins limited to pregnancy supplements	AWP, plus $4.40 dispensing fee	CN
Physical Therapy and Other Services
Occupational Therapy Services
No
Physical Therapy Services
No
Services for Speech, Hearing and Language Disorders
Yes			Audiology services limited to evaluation necessary for provision of hearing aid	Fee for service	CN
Products and Devices
Dentures
Yes			Limited to post-trauma only	Fee for service	CN
Eyeglasses
Yes		Yes	1 pair eyeglasses/2 years if minimum diopter correction criteria met	Fee for service up to $80 maximum	CN
Hearing Aids
Yes		New or replacement hearing aid	1 hearing aid/3 years	Fee for service	CN
Medical Equipment and Supplies
Yes				Fee for service	CN
Prosthetic and Orthotic Devices
Yes			Limited to cardiac devices and intraocular lenses for cataracts	Fee for service	CN
Transportation Services
Ambulance Services
Yes				Reasonable charge for off-island transport, federal Medicaid funds not claimed for on-island transport	CN
Non-Emergency Medical Transportation Services
No
Other Services
Diagnostic, Screening and Preventive Services
Yes			Specified coverage criteria for screening services	Fee for service	CN
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes				Fee for service	CN
Targeted Case Management
No

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
No
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes	Therapies not covered	Negotiated rate/service	CN
Hospice Care
No
Personal Care Services
No
Private Duty Nursing Services
No
Program of All-Inclusive Care for the Elderly
No
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
No
Inpatient Psychiatric Services, under age 21
No
Intermediate Care Facility Services for the Mentally Retarded
No
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes	180 days/year	Negotiated rate/service	CN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: Like the other territories, Guam has a federal Medicaid financial participation rate of 50 percent, payable up to a ceiling specified in law. The Deficit Reduction Act of 2005 provided additional funds to the territory, thus increasing its payment ceiling for fiscal years 2006 and 2007. The ceilings for 2008 and subsequent years will be calculated by applying an adjustor, the medical care component of the Consumer Price Index, to the 2007 payment ceiling.