Orlando Harmon
Medicaid is a US government-funded health insurance program that provides free or low-cost health coverage to low-income individuals, families, children, pregnant women, the elderly, and people with disabilities. Each state has its own eligibility criteria, and enrollment process, and the benefits offered may vary. To determine whether your health insurance is a Medicaid plan, you can contact your state's Medicaid agency, check the official US government website for Medicaid, or refer to your insurance documentation.
| Characteristics | Values |
|---|---|
| Coverage | Medicaid provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. |
| Eligibility | Eligibility is based on age, financial circumstances, family situation, or living arrangements. |
| Enrollment | Enrollment is done through the Health Insurance Marketplace or the state agency. |
| Benefits | Medicaid covers prescription drugs, home care, non-emergency medical transportation, and comprehensive benefits for children, known as Early Periodic Screening Diagnosis and Treatment (EPSDT) services. |
| Provider Acceptance | Not all providers accept Medicaid. |
| Cost | Medicaid may have small co-payments, which can be waived if unaffordable. |
| Coverage for Previous Medical Expenses | Medicaid may cover medical expenses from the last three months, even if the individual was not enrolled at the time. |
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What You'll Learn
Income eligibility
Medicaid is a federal-state partnership, and while there are federal guidelines, states have flexibility in how they implement the program, including income eligibility criteria. As a result, income limits vary by state and are subject to change over time. For example, in April 2025, persons residing in Medicaid-funded nursing homes were permitted to have a monthly income of up to $2,901. However, this income limit may differ from those for other Medicaid programs, such as Medicaid Home and Community-Based Services or the Aged, Blind, and Disabled Medicaid programs.
In addition to income, states may consider other factors, such as family size, age, financial circumstances, family situation, and living arrangements. They may also have additional options for coverage, such as including individuals receiving home and community-based services and children in foster care. For example, young adults who meet the eligibility requirements as former foster care recipients are eligible for Medicaid at any income level.
To determine specific income eligibility for Medicaid, individuals should refer to their state-specific guidelines and consider seeking advice from health insurance experts or Medicaid Planning Professionals. These professionals can provide guidance on complex techniques to help individuals become eligible for Medicaid, even if their income exceeds the limits. Additionally, states may offer alternative pathways to eligibility, such as the Medically Needy Pathway, or allow the use of Miller Trusts or Qualified Income Trusts to help individuals become income-eligible.
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Coverage and care
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to some low-income people, families, children, pregnant women, the elderly, and people with disabilities. The percentage of people who report having Medicaid is 21% nationally, but this ranges from 11% in Utah to 34% in New Mexico. In 2023, Medicaid covered nearly 4 in 10 children, over 8 in 10 children in poverty, 1 in 6 adults, and almost half of adults in poverty.
Medicaid beneficiaries have substantially better access to care than people who are uninsured, and they are less likely to postpone or go without needed care due to cost. Federal rules generally limit out-of-pocket costs for Medicaid. Key measures of access to care among Medicaid enrollees are generally comparable to rates for people with private insurance. However, gaps in access to certain providers (e.g. psychiatrists and dentists) is an ongoing challenge in Medicaid.
Medicaid provides comprehensive health coverage, and the services covered depend on your age, financial circumstances, family situation, or living arrangements. These services are provided through a large network of healthcare providers that you can access directly using your Medicaid card or through your managed care plan if you are enrolled in managed care. Some services may have small co-payments, which can be waived if you cannot afford them.
Some Medicaid programs pay for your care directly, while others use private insurance companies to provide Medicaid coverage. In all states, CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. Each state works closely with its state Medicaid program, and Medicaid benefits differ in each state.
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Medicaid expansion
Under the expansion guidelines, Medicaid eligibility is extended to adults under the age of 65 with incomes up to 138% of the federal poverty level (FPL). This is calculated as 133% plus a 5% income disregard. Prior to the ACA, Medicaid was generally unavailable to non-disabled adults under 65 unless they had minor children, and even then, income caps were very low.
The U.S. Supreme Court has ruled that the Medicaid expansion is voluntary for states, and so some states have not expanded their programs. As of early 2025, 40 states and the District of Columbia had adopted the expansion, with Oklahoma, Missouri, South Dakota, and North Carolina being the most recent additions. Wisconsin and Georgia have partially expanded Medicaid, but do not receive the enhanced federal funding available to full expansion states. The federal government initially paid 100% of the cost of expansion coverage from 2014 to 2016, with the federal share dropping gradually to 90% for 2020 and each year thereafter.
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Applying for Medicaid
To apply for Medicaid, you must be a resident of the state in which you are applying for benefits. Each state has its own requirements, but eligibility generally depends on a combination of age, financial circumstances, family situation, and living arrangements.
Firstly, create an account with the Health Insurance Marketplace and fill out an application. If it looks like anyone in your household qualifies for Medicaid, your information will be sent to your state agency. They will then contact you about enrollment.
When you apply for Medicaid, you may need to provide certain information or documentation. What is required depends on your state. Your state Medicaid agency may ask for information about an insurance plan offered by your employer or an insurance plan you currently have. To find out what documentation you need, check with your state's Medicaid agency.
Your state may review your information each year to decide if you are eligible for Medicaid. If they need more information from you, they will contact you about renewing your coverage.
It's important to note that not every provider accepts Medicaid. To locate a Medicaid medical provider, find and check with your state's Medicaid agency.
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Medicaid and CHIP
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to some low-income individuals, families, children, pregnant women, the elderly, and people with disabilities. The coverage and costs of Medicaid and CHIP may differ between states. While Medicaid is a federal program, CHIP is managed by states according to federal requirements.
Medicaid programs must follow federal guidelines, but each state's Medicaid agency decides on eligibility and coverage. Some states have expanded their Medicaid programs to cover all people below certain income levels. In some cases, even if you don't qualify for Medicaid based on income, you should still apply, as you may qualify for your state's program, especially if you have children, are pregnant, or have a disability.
CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but too little to afford private coverage. CHIP qualifications are different in every state, and in some states, CHIP covers pregnant people. If your income is too high for Medicaid, your child may still qualify for CHIP.
To apply for Medicaid and CHIP, you must create an account with the Health Insurance Marketplace and fill out an application. If it appears that anyone in your household qualifies for either program, your information will be sent to your state agency, which will contact you about enrollment. Your state may review your information annually to determine your eligibility for Medicaid.
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Frequently asked questions
If you are enrolled in a health plan through Medicaid or CHIP, contact the member services phone number on your eligibility letter or the back of your enrollment card. This information should also be available on the websites of your health plan or Medicaid/CHIP agency.
Medicaid provides comprehensive health coverage, including a wide range of services depending on your age, financial circumstances, family situation, or living arrangements. This includes long-term care, non-emergency medical transportation, and comprehensive benefits for children, known as Early Periodic Screening Diagnosis and Treatment (EPSDT) services.
Create an account with the Health Insurance Marketplace and fill out an application. If it appears that anyone in your household qualifies for Medicaid or CHIP, your information will be sent to your state agency, and they will contact you about enrollment.
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to low-income individuals, families, children, pregnant women, the elderly, and people with disabilities. CHIP provides low-cost health coverage to children in families that earn too much to qualify for Medicaid, and the qualifications differ across states.
Ask your current doctor or pharmacist if they accept Medicaid. If not, you may be able to continue seeing your current provider for a short time while you search for a new one who accepts Medicaid.
