Medicaid OTC Benefits: Allowances by Plan and What’s Covered

Reviewed October 26, 2026. Medicaid OTC benefits come in two forms. First, state Medicaid programs can cover certain over-the-counter medicines, usually when a doctor writes a prescription or order. Second, many Medicaid health plans add an OTC allowance, often $10 to $30 a month per household, that you spend on items such as pain relievers, cold medicine, vitamins and first aid supplies.

Quick answer: Check two things: your state’s covered OTC drug list (ask your doctor and pharmacy) and your Medicaid plan’s OTC catalog. Plan allowances vary widely. Sunshine Health in Florida lists $25 per household per month, Humana Healthy Horizons in Florida lists $65 per household per quarter, and some plans offer none. If you also have Medicare, a D-SNP may give you a larger allowance in 2027.

1. OTC medicines Medicaid covers with a prescription

Federal law lets states choose whether to cover nonprescription drugs. Section 1927(d)(2) of the Social Security Act lists “Nonprescription drugs” among the drug classes that “may be excluded from coverage or otherwise restricted.” Many states still cover a list of OTC products when they’re prescribed or ordered by an enrolled provider:

• North Carolina: Medicaid’s Clinical Coverage Policy 9A (amended July 1, 2026) says “Selected non-legend, over-the-counter (OTC) products may be covered as an optional benefit,” dispensed by a pharmacist with a lawful prescription.
• New York: NYRx publishes a covered OTC drug list of products “members may receive from a pharmacy with an order from an NYRx enrolled prescriber.” Since April 1, 2025, NYRx no longer covers some items, including some decongestants, glucose tablets and multivitamins for members 21 and older.
• Ohio: Ohio Medicaid covers OTC drugs that appear on its “OH PBM OTC List.”
• Texas: UnitedHealthcare Community Plan’s Texas STAR page says, “We also cover over-the-counter medicines with a written order from your doctor.”

This kind of coverage doesn’t use an allowance. The pharmacy bills Medicaid, just as it would for a prescription drug. Ask your doctor to write an order for an OTC medicine you use often, and ask your pharmacist whether it’s on your state’s list.

2. Medicaid plan OTC allowances by plan

Most people searching for Medicaid OTC benefits mean the allowance that Medicaid managed care plans offer as a value-added or expanded benefit. Each plan sets its own amount and rules. These figures come from the plans’ own pages:

Plans can change these benefits each contract year, and some states run Medicaid contracts on a July or September cycle rather than a calendar year. Check your plan’s current catalog before you order. Some plans, such as CareSource in Georgia, offer rewards cards instead of an OTC allowance. Our state and plan guides go deeper: Sunshine Health OTC benefits, Humana Medicaid OTC benefits and Georgia Medicaid OTC benefits.

What Medicaid OTC allowances usually cover

Plan catalogs differ, but common categories include:

• Pain and fever relievers
• Cough, cold and allergy medicine
• Digestive health products, such as antacids
• First aid supplies, such as bandages and antiseptics
• Vitamins and some supplements
• Oral care, skin care and other personal care items
• Baby care items on some plans

Common exclusions are cosmetics, food (unless your plan has a separate food benefit), tobacco, alcohol and items not in the catalog. Carolina Complete Health, for example, excludes cosmetics, food supplements and replacement items such as hearing aid batteries. See our list of what you can get with an OTC card.

How to use your Medicaid OTC benefits

1. Find your plan’s OTC catalog on the plan website or ask Member Services to mail one.
2. Set up your ordering account. Many plans use CVS Health’s OTC Health Solutions at cvs.com/benefits; you’ll need your member ID, date of birth and ZIP code.
3. Order before the deadline. Aetna Better Health of Michigan, for example, needs orders by 11:59 p.m. on the last day of the month, and most plans don’t roll unused money over.
4. Choose delivery or pickup. Some plans let you shop at participating CVS stores; not every store takes part.

New to Medicaid or choosing a plan? Our guide on how to apply for an OTC card with Medicaid walks through each step, and OTC benefits at CVS explains in-store ordering.

Medicaid OTC benefits if you also have Medicare

People with both Medicare and Medicaid can often choose a Dual Eligible Special Needs Plan (D-SNP). CMS says Medicare Advantage plans “may offer OTC items as a supplemental benefit,” and D-SNP allowances are often bigger than Medicaid plan allowances. Community DualCare Access in Texas listed up to $100 a month for approved OTC items in 2026. Many D-SNPs put the allowance on a prepaid card, and some add food and utility money for members with qualifying chronic conditions.

2027 Medicare Advantage plans, including D-SNPs, were published on October 1, 2026, and Open Enrollment runs October 15 to December 7, 2026. Full-benefit dual eligibles can also use a monthly special enrollment period to join an integrated D-SNP aligned with their Medicaid plan. See Medicare Advantage plans with OTC benefits and carrier guides such as Molina OTC benefits and Healthfirst OTC Plus card.

Frequently asked questions

Does Medicaid cover over-the-counter medicine?

It depends on your state. Federal law lets states exclude nonprescription drugs, but many states, including North Carolina and New York, cover a list of OTC products when a provider writes a prescription or order.

How much are Medicaid OTC benefits?

Plan allowances we found range from $10 a month (Peach State in Georgia) to $25 a month (Sunshine Health in Florida and Aetna Better Health of Michigan), or $25 to $65 a quarter. Many limits are per household.

What are Florida Medicaid OTC benefits?

Sunshine Health lists $25 per household per month and Humana Healthy Horizons in Florida lists $65 per household per quarter. Other Florida plans set their own amounts.

What are Texas Medicaid OTC benefits?

Texas Medicaid can cover some OTC medicines with a written order from your doctor, as UnitedHealthcare Community Plan’s STAR page notes. Allowances vary by plan, so check your plan’s value-added services list for the current contract year.

Are Aetna Medicaid OTC benefits the same in every state?

No. Aetna Better Health lists $25 a month per household in Michigan, $25 a quarter per household in Louisiana and $15 a month for members ages 0 to 18 in Kentucky.

Do Medicaid OTC benefits roll over?

Usually not. Most plans reset the allowance each month or quarter. Peach State in Georgia is an exception, allowing rollover for up to 3 months.

This article is general information. Medicare365 is not affiliated with or endorsed by any state Medicaid agency, Medicaid health plan or U.S. government agency. Benefits vary by state and plan and can change each contract year; check your member handbook or call the number on your member ID card.

Sources

• Social Security Act Section 1927 (ssa.gov)
• NC Medicaid: Clinical Coverage Policy 9A, over-the-counter products
• New York State DOH: NYRx covered OTC drug list
• New York State DOH: NYRx OTC member notice
• Ohio Administrative Code 5160-9-03
• UnitedHealthcare Community Plan of Texas: STAR
• Sunshine Health: OTC catalog (2026)
• Humana Healthy Horizons in Florida: Expanded benefits
• Peach State Health Plan: Over-the-counter items
• Aetna Better Health of Louisiana: OTC benefit
• Aetna Better Health of Kentucky: OTC products for kids
• Aetna Better Health of Michigan: OTC benefit
• Carolina Complete Health: OTC catalog
• CMS: Medicare Managed Care Manual, Chapter 4
• Community Health Choice: Community DualCare Access 2026 Summary of Benefits