Jeffrey Wade
Medicaid is a federal and state-funded health insurance program in the United States that provides coverage for low-income children, adults, seniors, pregnant women, and people with disabilities. It is the largest source of funding for medical and health-related services for people with low incomes in the United States, providing free health insurance to about 85 million low-income and disabled people as of 2022. The program is administered by states within broad federal rules, and while all states are required to provide some Medicaid benefits, they have flexibility in determining what populations and services to cover, resulting in variations across states in program spending and the share of residents covered.
| Characteristics | Values |
|---|---|
| Total number of people served | 82 million (2024) to 92 million (2022) |
| Racial composition | 40% white, 21% black, 25% Hispanic, 14% other (2013) |
| Age composition | 37% children, 11% adults 65 and older (2017) |
| Types of services | Health insurance, long-term care, Medicare premiums, wraparound coverage for services not covered by Medicare |
| States with high enrollment numbers | California (23% of the population in 2009-10) |
| Spending per enrollee | $7,600 (2021) |
| Total annual cost | $870 billion (2023) |
| Funding sources | Jointly financed by states and the federal government |
| Eligibility | Low-income children, adults, seniors, pregnant women, and people with disabilities |
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What You'll Learn
Low-income children
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to almost 82 million low-income children, pregnant women, adults, seniors, and people with disabilities in the United States. In all states, Medicaid provides coverage for some low-income people, families, and children.
Medicaid is a major source of funding for hospitals, community health centers, physicians, and nursing homes. States operate their Medicaid programs within federal standards, but coverage and costs may vary from state to state. Some states have expanded their Medicaid programs to cover all people below certain income levels. For example, in Texas, children might be able to get low-cost or free health coverage through Children's Medicaid or CHIP. Children's Medicaid is a healthcare program for children in low-income families, while CHIP is for children whose families earn too much to qualify for Medicaid but cannot afford health insurance.
If a family's income is too high for Medicaid, their children may still qualify for CHIP. CHIP qualifications differ in every state, but in most cases, they depend on income. CHIP fees vary based on income, with enrollment fees of $50 or less per family per year, and co-pays for doctor visits and medicine ranging from $3 to $5 for lower-income families and $20 to $35 for higher-income families.
All states must offer former foster children uninterrupted Medicaid coverage until they turn 26, provided that certain conditions are met. Additionally, children with disabilities who are 19 or 20 years old may qualify for Medicaid in some cases. If a child with a disability does not qualify for Children's Medicaid due to their family's income, the family may be able to obtain coverage through the Medicaid Buy-In for Children (MBIC) program, which allows them to make monthly payments for Medicaid coverage.
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Pregnant women
Medicaid is a government-sponsored health insurance program for low-income families who have no medical insurance or inadequate insurance. All states offer Medicaid or a similar program to help pregnant women receive adequate prenatal and postpartum care.
Medicaid provides health coverage to low-income pregnant women during pregnancy and up to 12 months postpartum. Pregnant women are usually given priority in determining Medicaid eligibility, and most offices try to qualify a pregnant woman within about 2-4 weeks. If you need medical treatment before then, you can talk with your local office about a temporary card.
Medicaid for Pregnant Women includes the full array of Medicaid services, such as prenatal doctor visits, prenatal vitamins, labor and delivery, and checkups and other benefits for the baby after leaving the hospital. These services are provided by health plans, and income is a major factor in determining eligibility. If you get Medicaid or CHIP Perinatal, you will choose a health plan from the ones available in your service area.
If you have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid coverage and will remain eligible for at least a year. This is true even if your pregnancy begins before your coverage starts. Maternity care and newborn care are essential health benefits.
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Seniors
Medicaid and the Children's Health Insurance Program (CHIP) provide health and long-term care coverage to almost 82 million low-income children, pregnant women, adults, seniors, and people with disabilities in the United States. According to a report from December 2024, 78,532,341 people were enrolled in Medicaid and CHIP across the 50 states and the District of Columbia.
Medicaid provides health coverage to 7.2 million low-income seniors who are also enrolled in Medicare. This accounts for more than 15% of all Medicaid enrollees. Seniors enrolled in both Medicaid and Medicare can be covered for both optional and mandatory categories. For example, Medicaid covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit, prescription drugs, eyeglasses, and hearing aids. Services covered by both programs are first paid by Medicare, with Medicaid covering the difference up to the state's payment limit.
Medicare enrollees with limited income and resources may receive assistance from Medicaid in paying their premiums and out-of-pocket medical expenses. Medicaid is also a major source of funding for hospitals, community health centers, physicians, and nursing homes.
Racial health coverage inequities are less stark in states that have expanded Medicaid eligibility. Closing the Medicaid coverage gap is key to reducing these coverage inequities in non-expansion states, particularly among people with low incomes. For example, Black people have disproportionately high uninsured rates and disproportionately reside in non-expansion states.
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People with disabilities
Medicaid and the Children's Health Insurance Program (CHIP) provide health and long-term care coverage to almost 82 million low-income children, pregnant women, adults, seniors, and people with disabilities in the United States. Over 10 million children and adults with disabilities rely on Medicaid for their health coverage, comprising about 15% of all Medicaid beneficiaries.
Medicaid provides a full range of coverage for people with disabilities, including preventive services, primary and specialty care, prescription drugs, medical equipment, and long-term services and supports. The program is a lifeline for people with disabilities, ensuring they have access to the care and services they need. Medicaid beneficiaries with disabilities may have physical impairments and injuries, intellectual and developmental disabilities, mental and behavioral health disorders, or other conditions. About 40% of Medicaid beneficiaries with disabilities are also enrolled in Medicare, with Medicaid covering many services that Medicare does not, including long-term services and supports, and, depending on the state, dental, vision, and hearing services.
National data show that people with disabilities who are covered by Medicaid are as likely as those with Medicare or private insurance to have a primary care doctor. They also report fewer unmet needs overall and fewer unmet needs due to cost. Medicaid is a major source of funding for hospitals, community health centers, physicians, and nursing homes. States operate their Medicaid programs within federal standards and a wide range of state options in exchange for federal matching funds.
Eligibility for Medicaid for people with disabilities varies by state. In many states, recipients of Supplemental Security Income (SSI) automatically qualify for Medicaid and don't need to fill out an application. In other states, SSI guarantees Medicaid eligibility, but individuals must sign up for it. In a few states, SSI does not guarantee Medicaid eligibility, but most SSI recipients are still eligible. Individuals who need to apply for Medicaid can do so through their state's program. For example, in Texas, individuals can apply for Medicaid for the Elderly and People with Disabilities if they are a resident and a U.S. citizen or qualified non-citizen. During the application process, they will be asked about their income, age, and disability status to determine their eligibility.
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Racial and ethnic minorities
Medicaid expansion has also been associated with improved health outcomes, including reduced premature deaths and improved maternal mortality rates, particularly for Black women. Racial health coverage inequities are less stark in states that have expanded Medicaid eligibility, and expansion has been key to reducing coverage inequities in non-expansion states, especially for low-income individuals. For example, a 2018 JAMA study found that Medicaid expansion led to reductions in mortality from end-stage renal disease, with notable improvements for Black people who are at higher risk for kidney failure.
However, it is important to note that racial and ethnic disparities in coverage persist, and these disparities could widen due to potential Medicaid cuts and policy changes. As of 2023, states that have not expanded Medicaid have higher uninsured rates across most racial and ethnic groups. Black and Latino people are disproportionately affected by the coverage gap, with 45% of Black people under 65 living in non-expansion states compared to 31% of the total population in the same age group.
Additionally, American Indians and Alaska Natives (AIAN) rely on the Indian Health Service (IHS) for healthcare, but IHS is not health insurance and is often underfunded. As a result, Medicaid coverage is critical for eligible AIAN individuals who have no insurance or rely on IHS. While the ACA and Medicaid expansion have made progress in addressing racial and ethnic disparities in health coverage, ongoing challenges remain, and further efforts are needed to ensure equitable access to healthcare for all racial and ethnic minorities.
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Frequently asked questions
Eligibility for Medicaid insurance is based on income. In most states, any member of a household with an income up to 138% of the federal poverty line qualifies for Medicaid coverage.
Medicaid provides health insurance coverage to more people than any other single program in the United States. As of 2022, Medicaid served over 92 million people.
Medicaid serves low-income children, adults, seniors, and people with disabilities. It also covers pregnant women and is a key source of coverage for individuals experiencing homelessness and those transitioning out of carceral settings.
Medicaid is jointly financed by states and the federal government but administered by states within broad federal rules.
