Having been a consultant for many years at the IL Dept. of Public Aid (the MEDICAID agency), I can answer for IL based on experience.
Each state can optionally cover some aspects and receive the Federal matching funds commensurate with their coverage and documentation. IL, at the time, was a 50% match. All states cover basically what Medicare covers at Federal direction but, again, can add services.
IL had no limitation on service to a recipient and no co-pays of any kind. They made a half-hearted attempt at collection from third party payers if the individual may have been covered by some sort of insurance. While some procedures required prior approval, if the doctor recommended it, the procedure was almost always approved. And, yes, that included organ transplants and the like. Do not recall seeing any sex-change procedures but then when I was there, that wasn’t so ‘common’.
The only safeguard against overuse of the MEDICAID system was the low reimbursement rate for everyone other than hospitals and nursing homes who were paid very well. IL had to pay less than what Medicare paid for a doctor’s procedure and that Medicare payment was low to begin with.
At one point IL paid $8.10 for a common office visit. That visit cost you or me $25.00. The state rate only went up if the Fed rate went up and, as doctors lost money on MEDICAID clients, it wasn’t long before you and I were paying $65.00 for that same visit. The only other way to make money as a physician was to herd patients through like cattle and make money in bulk.
Sadly, MEDICAID was some good coverage. Too good, and it was abused until it became a lifetime ‘right’. Hey, costs me nothing to go to the doctor/hospital/dentist/whatever, I have my green card (the IL MEDICAID card which was never green to my knowledge - color based on your status).
Yhanks, that’s pretty informative.
bkmk