Alabama Medicaid pays for doctor visits, hospital care, prescriptions, lab work, maternity care, behavioral health, nursing home care and medical transportation, but several of those benefits carry hard caps most states do not use. The two that matter most to adults: Medicaid covers 14 doctor visits per calendar year, and most adults are limited to 5 prescriptions per month, 4 of which may be brand name. Dental and hearing services stop at age 21 for nearly everyone. Everything below comes from the Alabama Medicaid Agency's covered services handbook, current as of September 2026.
For income thresholds and who qualifies, see our guides on Alabama Medicaid eligibility and Alabama Medicaid income limits. This page is about coverage, not qualification.
Alabama Medicaid Covered Services and Limits in 2026
| Service | What Alabama Medicaid covers | Limit |
|---|---|---|
| Doctor visits | Office, emergency room and healthcare clinic visits | 14 per calendar year |
| Doctor care in the hospital | Physician visits during an inpatient stay | 16 days |
| Inpatient hospital | Semiprivate room, medically necessary care | No day limit |
| Outpatient hospital | Emergency and non emergency visits | No limit for lab, X ray, radiation, chemo |
| Ambulatory surgical center | Outpatient surgical procedures | 3 per calendar year |
| Prescription drugs | Most medicines a doctor orders | Most adults: 5 per month, 4 brand name max |
| Renal dialysis | Outpatient dialysis treatments | 156 per year |
| Eye care, age 21 and older | Eye exam and eyeglasses | Once every 2 calendar years |
| Eye care, children | Eye exams | Once a year, more if medically necessary |
| Dental | Preventive and restorative care | Under 21, plus pregnancy to 60 days postpartum |
| Hearing | Screenings and hearing aids | Under 21 only |
| Hospice | Care for terminally ill beneficiaries | Covered |
| Home health | Skilled care and some home supplies | Homebound beneficiaries |
| Nursing home | Room, board and prescribed medicines | Medically necessary |
| Family planning | Birth control, sterilization at 21 and older | Separate from doctor visit cap |
| Transportation | Ambulance and non emergency rides | Prior approval for non emergency |
Source: Alabama Medicaid Agency, Your Guide to Medicaid Covered Services, information current as of September 2026.
The 14 doctor visit limit, explained
The 14 visit cap covers a doctor's office, the emergency room and healthcare clinics combined. Once you use all 14, Medicaid will not pay for more visits that year. Three exceptions keep it from being as tight as it looks:
- Children get more. Beneficiaries under 21 can get extra visits through the EPSDT Well Child Checkup program when a screening finds a problem that needs treatment.
- Family planning visits are separate. Family planning services do not count against your regular office visits.
- Community mental health is separate. Services from a community mental health center do not count against regular doctor's office visits.
Hospital physician care counts separately: Medicaid pays for 16 days of a doctor's care while you are an inpatient, outside the 14 visit total. The My Medicaid portal shows how many visits you have left.
Prescription drug coverage and the 5 drug monthly limit
Alabama Medicaid pays for most medicines a doctor orders, and some require prior approval. Alabama has also run a monthly prescription count limit since October 2013: in most cases, adults are limited to 5 drugs per month, no more than 4 of which may be brand name. Several carve outs widen that:
- Three month maintenance supplies do not count toward the limit, and many chronic condition drugs are dispensed that way on purpose.
- Children and nursing home residents are exempt entirely.
- Antipsychotic drugs, HIV drugs and seizure drugs are exempt.
- Alabama publishes a Prescription Limit Exceptions drug list, current version effective October 1, 2026.
If you hit the limit mid month, ask your prescriber whether any of your drugs are on the exceptions list or can move to a three month supply.
Dental coverage: children yes, most adults no
Dental is where Alabama diverges most sharply from other state Medicaid programs.
Children under 21 with full Medicaid get the Alabama Medicaid Dental Program, covering certain routine preventive and restorative services. Most children lose SOBRA Medicaid after turning 19 unless they qualify under another category.
Pregnant beneficiaries age 21 and older have had dental coverage since October 1, 2022, during pregnancy and through 60 days postpartum, from an Alabama Medicaid enrolled dental provider.
Everyone else age 21 and older has no dental benefit; the pregnancy window is the only exception. Braces, routine partials, dentures, bridgework, gold caps or crowns, and periodontal surgery are not covered at any age, and adults eligible for family planning services only get no dental coverage.
Eye care and hearing
Adults 21 and older get an eye exam and eyeglasses once every two calendar years. Children get an eye exam once a year, or more often when medically necessary. Contact lenses require approval ahead of time and are covered only in certain situations. Hearing services, including screenings and hearing aids, are a children's benefit; hearing services at 21 and older appear on the not covered list.
Hospital, surgery and lab
Inpatient hospital days are unlimited when care is medically necessary. Coverage is for a semiprivate room; request a private room and you pay the difference. Outpatient hospital care is covered for emergency and non emergency visits, with no limit at all on outpatient visits for lab work, X rays, radiation or chemotherapy. Surgery in an ambulatory surgical center is capped at 3 procedures per calendar year. Psychiatric hospital services are covered for children under 21 and adults over age 65.
Behavioral health and substance use treatment
Alabama Medicaid pays for treatment of mental illness and substance use disorder through licensed psychologists and community mental health centers. The Alabama Department of Mental Health administers intensive home based services for children and youth with autism spectrum disorder or serious emotional disturbance, and Applied Behavior Analysis therapy is covered for autism when delivered by a qualified behavior analyst, psychologist or psychiatrist, or staff under their supervision. None of these services carry a copayment.
Maternity and newborn care
If you are pregnant and on Medicaid, you must contact the Alabama Coordinated Health Network (ACHN) in your region to arrange maternity services. The handbook warns you may be responsible for paying your own maternity care if you do not. You can see any OB/GYN or doctor enrolled with Medicaid.
Covered care includes prenatal visits, delivery, postpartum care and prenatal vitamins. The Nurse Family Partnership program covers home visiting before and after birth, plus infant care until the child turns 2. Nurse midwife services are also covered.
Long term care and home based waivers
Nursing home care covers room, board and medicines prescribed by a doctor. Alabama also pays for Post Hospital Extended Care, which covers nursing home level services in a hospital for patients waiting on a placement.
For people who want to stay home instead, Alabama runs seven Home and Community Based waivers: Alabama Community Transition, Elderly and Disabled, Living at Home, State of Alabama Independent Living, Technology Assisted for Adults, Intellectual Disabilities, and the Community Waiver Program. The Program of All Inclusive Care for the Elderly (PACE) serves elderly and disabled adults in Baldwin and Mobile counties who would otherwise need nursing home care. Most long term care beneficiaries are also enrolled in the Integrated Care Network, which adds case management.
Remote Patient Monitoring
Alabama Medicaid covers in home Remote Patient Monitoring for beneficiaries who need daily monitoring and have congestive heart failure, diabetes, gestational diabetes, hypertension including maternal hypertension, or pediatric asthma. A referral from any source, including a doctor, caregiver or health department, is enough to enter. It is available statewide except in Mobile County. Ask your ACHN care coordinator.
Transportation
Ambulance service is covered only when medically necessary, judged by the patient's condition at the time of transport. If another form of transportation can be used without harming the patient's health, Medicaid will not pay for it. The Non Emergency Transportation program covers rides to medically necessary appointments for beneficiaries with no other way to get there without obvious hardship, with approval in advance. Call 800-362-1504. Rides to children's EPSDT screenings and follow up care are also covered.