| 3H 1 |
| 3H-1, Home Infusion Therapy |
| 3K-1, Community Alternatives Program for Children (CAP/C) |
| 3K-2, Community Alternatives Program for Disabled Adults (CAP/DA) |
| 3L, State Plan Personal Care Services (PCS) |
| 4A |
| 4A, Dental Services |
| 4B |
| 4B, Orthodontic Services |
| 5A 1 |
| 5A 2 |
| 5A 3 |
| 5A-1, Physical Rehabilitation Equipment and Supplies |
| 5A-2, Respiratory Equipment and Supplies |
| 5A-3, Nursing Equipment and Supplies |
| 5B |
| 5B, Orthotics & Prosthetics |
| 6A |
| 6A |
| 6A, Routine Eye Exam and Visual Aids for Recipients Under Age 21 |
