Jeffrey Wade
Medicaid is a joint federal and state program that provides health coverage to over 77.9 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. The Affordable Care Act of 2010 allowed states to expand Medicaid to cover nearly all low-income Americans under 65, with eligibility depending on income, household size, family status, disability, age, and other factors. Each state has its own requirements, and while some states have expanded Medicaid, others have not. If you have no insurance, you can apply for Medicaid through the Health Insurance Marketplace to see if you qualify.
| Characteristics | Values |
|---|---|
| Purpose | Provide funding for the U.S. healthcare system |
| Coverage | 77.9 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities |
| Eligibility | Low-income Americans under the age of 65 |
| Application | Through the Health Insurance Marketplace |
| Coverage Start Date | Date of application or the first day of the month of application |
| Retroactive Coverage | Up to three months prior to the month of application |
| Coverage End | End of the month when eligibility requirements are no longer met |
| State Flexibility | Each state has its own eligibility rules and benefits |
| Payment | Depends on the family's income |
| Additional Benefits | Non-emergency medical transportation, prescription drugs, and home care |
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What You'll Learn
Income and eligibility
The Affordable Care Act of 2010 (ACA) established a new methodology for determining income eligibility for Medicaid, based on Modified Adjusted Gross Income (MAGI). MAGI considers an individual's taxable income and tax filing relationships to determine financial eligibility. It replaced the previous process, which was based on the methodologies of the Aid to Families with Dependent Children program that ended in 1996. MAGI is used to determine eligibility for Medicaid, Children's Health Insurance Program (CHIP), and premium tax credits and cost-sharing reductions available through the health insurance marketplace.
While MAGI is the primary basis for determining Medicaid income eligibility, some individuals are exempt from these rules. These include people whose eligibility is based on blindness, disability, or age (65 and older). For these individuals, Medicaid eligibility is generally determined using the income methodologies of the Supplemental Security Income (SSI) program administered by the Social Security Administration. Additionally, certain Medicaid eligibility groups, such as children in foster care, do not require a determination of income by the Medicaid agency.
Medicaid eligibility is also influenced by factors beyond income. To be eligible for Medicaid, individuals must meet specific non-financial criteria. They must be residents of the state in which they are receiving Medicaid and either be citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. Furthermore, some eligibility groups are limited by age, pregnancy, or parenting status. For example, former foster children can receive uninterrupted Medicaid coverage until they turn 26, and children with an adoption assistance agreement in effect under Title IV-E of the Social Security Act are automatically eligible.
It is important to note that income is not the sole factor in determining eligibility for Medicaid long-term care. There are also asset limits and level of care requirements that vary by state and the specific type of Medicaid being applied for. Additionally, exceeding the income limit does not necessarily disqualify an individual from Medicaid; there may be other factors that come into play.
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Coverage options
Medicaid is a joint federal and state program that provides health coverage to over 77.9 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. The Affordable Care Act of 2010 allowed states to expand Medicaid to cover nearly all low-income Americans under 65. As of 2025, 41 states have expanded Medicaid under the Affordable Care Act, with rates of coverage higher in states with lower average incomes and lower rates of health insurance offered through employers.
Eligibility for Medicaid depends on a variety of factors, including income, household size, family status, disability, and age. These factors vary from state to state, and each state has its own requirements. Generally, Medicaid eligibility is determined by a combination of these factors. Some states allow individuals to "spend down" their income to qualify for Medicaid. This means that individuals can pay for non-covered medical expenses until their income is lowered to a level that qualifies them for Medicaid.
To apply for Medicaid, individuals must create an account with the Health Insurance Marketplace and fill out an application. If it appears that anyone in the household qualifies for Medicaid or CHIP, the information will be sent to the state agency, which will then contact the applicant about enrollment. The state may review the applicant's information annually to determine continued eligibility.
Medicaid provides comprehensive coverage, including prescription drugs, home care, non-emergency medical transportation, and comprehensive benefits for children. Some Medicaid programs pay for care directly, while others use private insurance companies to provide coverage. In some cases, Medicaid may even cover medical care from the last three months if the individual was eligible during that period, even if they were not enrolled at the time.
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Applying for Medicaid
Medicaid provides free or low-cost medical benefits to eligible people with low incomes. It covers 19% of all healthcare spending and 61% of total spending on long-term care in the US. It also covers non-emergency medical transportation and comprehensive benefits for children.
Each state has its own requirements for Medicaid eligibility, which may include income, household size, family status (such as pregnancy or young children), disability, age, and other factors. All states must offer former foster children uninterrupted Medicaid coverage until they turn 26.
If you think you may be eligible for Medicaid, you can apply through the Health Insurance Marketplace. You will need to create an account and fill out an application. If it looks like anyone in your household qualifies, your information will be sent to your state agency, and they will contact you about enrollment. You can also call the Marketplace Call Center at 1-800-318-2596 to apply. When applying, you may need to provide certain information or documentation, such as employer and income information for everyone in your family.
If you are applying for Medicaid for adults over age 19 with disabilities, or who are 65 or older, or for anyone who needs long-term care, you may need to complete additional forms, such as the ABD-LTC Application and the Application for Health Coverage & Help Paying Costs. You may also need to complete the Medically Needy Spenddown if you have income greater than the Medicaid limit, or the Nursing or Community-Based Care form if you need help with everyday tasks or have a physical disability, chronic disease, mental or emotional illness, or addiction disorder.
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Medicaid and Medicare
Medicaid is a joint federal and state program that helps cover medical costs for certain low-income people, including families and children, pregnant women, the elderly, and people with disabilities. The eligibility requirements and benefits vary from state to state, and each state runs its own program. Generally, eligibility is determined by income, household size, family status, disability, age, and other factors. Most states provide comprehensive coverage, and all states must offer former foster children uninterrupted Medicaid coverage until they turn 26.
Medicaid offers benefits not usually covered by Medicare, like nursing home care and personal care services. People with Medicaid usually don't have to pay anything for covered medical expenses but may owe a small co-payment for some items or services. Additionally, Medicaid may be able to help pay for medical care from the last three months, even if the person was not enrolled in Medicaid at the time.
Medicaid provides a major source of funding for the US healthcare system, covering 19% of all healthcare spending and hospital spending. It is the primary payer for long-term care in the US, covering 61% of total spending. Beyond long-term care, Medicaid provides other benefits not usually covered by health insurance, including non-emergency medical transportation and comprehensive benefits for children, known as Early Periodic Screening Diagnosis and Treatment (EPSDT) services.
To apply for Medicaid, individuals can create a Marketplace account on HealthCare.gov and complete an application. If the application shows that someone in the household might qualify for Medicaid, the Marketplace will forward the application to the applicant's state for a final eligibility decision. Alternatively, individuals can call the Marketplace Call Center or their State Medical Assistance (Medicaid) office for more information.
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State-specific rules
Medicaid provides a major source of funding for the US healthcare system, covering 19% of all healthcare spending and 61% of total spending on long-term care. While federal law sets broad requirements for Medicaid, each state has the responsibility of making policy and operational decisions that determine eligibility, covered services, and provider payments through its state plan. These state-specific rules mean that Medicaid benefits differ in each state, and rates of coverage vary. For example, the percentage of people with Medicaid is 21% nationally but ranges from 11% in Utah to 34% in New Mexico.
State plans must be approved by the Centers for Medicare & Medicaid Services and can be amended as needed to reflect changes in state policy and federal law and regulation. Section 1115 demonstration waivers allow states to test new approaches in Medicaid that differ from federal statute if the approach is likely to "promote the objectives of the Medicaid program." These waivers have been used to expand coverage, change policies, modify delivery systems, and make other program changes.
To determine Medicaid eligibility in your state, you can visit HealthCare.gov to create a Marketplace account and complete an application. If it appears that someone in your household may qualify for Medicaid, the Marketplace will forward your application to your state for a final eligibility decision.
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Frequently asked questions
You can apply for Medicaid by creating an account with the Health Insurance Marketplace and filling out an application. If it looks like anyone in your household qualifies, your information will be sent to your state agency, which will contact you about enrollment.
Eligibility requirements vary from state to state and may include income, household size, family status, disability, age, and other factors. In general, Medicaid provides free or low-cost medical benefits to low-income individuals and families.
Medicaid covers a range of services, including prescription drugs, home care, non-emergency medical transportation, and comprehensive benefits for children. It is the primary payer for long-term care in the United States and may also cover medical care from the last three months before enrollment.
