Who determines Medicaid coverage in the United States?

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Medicaid coverage is determined by the state Medicaid program within federal guidelines. The federal government funds the program and sets broad rules, but the state designs its own plan, defines eligibility within those rules, and decides which services are covered and how care is delivered (often through managed care). Local county departments assist with enrollment but do not set coverage, and private insurers are not the ones who determine Medicaid benefits—even though beneficiaries may access care through state-funded plans.