Jeffrey Wade
Medicaid is a federal-state program that provides health coverage for low-income individuals, families, children, pregnant women, the elderly, and people with disabilities. While Medicaid is a federal program, each state runs its own program with its own eligibility requirements and benefits, meaning coverage and costs vary from state to state. As of 2024, 10 states have not expanded their Medicaid eligibility rules, and it is unclear whether these states involve insurance companies in their Medicaid programs.
| Characteristics | Values |
|---|---|
| Percentage of people covered by Medicaid | 21% nationally, ranging from 11% in Utah to 34% in New Mexico |
| States that expanded Medicaid under the Affordable Care Act (ACA) | 41 |
| States that did not expand Medicaid as of 2024 | 10 |
| States that expanded Medicaid due to voter ballot measures | Unknown number, including Missouri |
| States that cover former foster children until age 26 | All |
| States that cover all people below certain income levels | Unknown number, including Missouri |
| States that cover low-income adults | Most, but not all |
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What You'll Learn
Eligibility criteria vary by state
Medicaid is a federal and state program that helps cover medical costs for certain low-income people, families, and children, pregnant women, the elderly, and people with disabilities. While there are federal guidelines that all state Medicaid programs must follow, each state runs its own program, and eligibility requirements and benefits can vary from state to state.
Eligibility criteria for Medicaid vary by state, and each state has its own set of rules and requirements. In general, to be eligible for Medicaid, individuals must meet their state's rules for income and resources, as well as other criteria such as being a resident of the state. Some states may also consider household size, family status (such as pregnancy or having young children), disability, age, and other factors. For example, some states may provide Medicaid coverage to all individuals below a certain income level, while others may have additional requirements.
The percentage of people with Medicaid coverage varies across states, ranging from 11% in Utah to 34% in New Mexico. States that have expanded Medicaid under the Affordable Care Act (ACA) tend to have higher coverage rates, and Medicaid covers a higher proportion of Black, Hispanic, and American Indian or Alaska Native (AIAN) children and adults compared to White individuals.
It is important to note that Medicaid coverage is not transferable between states. Individuals cannot use their Medicaid coverage from one state in another state they are visiting, except in cases of emergency health care. Therefore, it is essential to check the specific eligibility criteria and requirements of the state in which one resides to determine if they qualify for Medicaid coverage.
While the benefits offered by Medicaid may vary by state, there are some standard benefits provided across states. All states must cover prescription drugs and home care, also known as home- and community-based services (HCBS). Additionally, Medicaid is the primary payer for long-term care in the United States, covering 61% of total spending. Other benefits include non-emergency medical transportation and comprehensive benefits for children, known as Early Periodic Screening Diagnosis and Treatment (EPSDT) services.
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Income, household size, and family status are key factors
Medicaid is a joint federal and state program that provides health coverage to over 77.9 million Americans. It is the largest source of health coverage in the United States, covering 19% of all healthcare spending and 19% of hospital spending. Medicaid covers services required by federal law, but each state runs its own program with optional benefits, including prescription drugs and home care.
Additionally, Medicaid eligibility is often associated with specific populations, such as low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI). Certain eligibility groups, such as young adults who are former foster care recipients or children with adoption assistance agreements, are eligible at any income level. States may also have medically needy programs that provide pathways to eligibility for those with higher incomes.
It is important to note that eligibility requirements and benefits can vary from state to state, and some states have expanded their Medicaid programs to include more individuals. For example, as of January 1, 2025, Colorado children under 18 and pregnant individuals can apply for health coverage through Health First Colorado, regardless of their immigration status.
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Benefits vary by state
Medicaid is a joint federal and state program that helps cover medical costs for certain low-income people, families, children, pregnant women, the elderly, and people with disabilities. While there are federal guidelines that all state Medicaid programs must follow, each state runs its own program, and eligibility requirements and benefits vary from state to state.
Medicaid offers benefits that Medicare doesn't normally cover, like nursing home care and personal care services. People with Medicaid usually don’t pay anything for covered medical expenses but may owe a small co-payment for some items or services. Some states let you “spend down” the amount of your income that’s above the state’s Medicaid limit. You can do this by paying non-covered medical expenses and cost-sharing (like Medicare premiums and deductibles) until your income is lowered to a level that qualifies you for Medicaid.
In addition to covering the services required by federal Medicaid law, all states elect to cover optional benefits, including prescription drugs and home care. Home care is long-term care provided in non-institutional settings, including homes, daycare centers, and assisted living facilities. Other long-term care is provided in institutions such as nursing facilities. Beyond long-term care, Medicaid provides other benefits not usually covered by health insurance, including non-emergency medical transportation, which helps enrollees get to appointments, and comprehensive benefits for children, known as Early Periodic Screening Diagnosis and Treatment (EPSDT) services.
Eligibility for Medicaid is different in each state. Generally, you must meet your state’s rules for your income and resources, and other rules (like being a resident of the state). Each state and each family situation is different, so there’s no way to find out if you qualify without filling out an application. However, all states must offer former foster children uninterrupted Medicaid coverage until they turn 26.
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Some states expanded Medicaid under ACA
Medicaid is a joint federal and state program that helps cover medical costs for certain low-income people, families and children, pregnant women, the elderly, and people with disabilities. The Affordable Care Act (ACA) permits states to expand Medicaid coverage to adults with incomes up to 138% of the poverty level.
Several states had already expanded Medicaid benefits before the ACA was implemented. For example, between 2000 and 2005, Arizona, Maine, and New York significantly expanded Medicaid access to poor parents and childless adults. In 2008, Oregon offered Medicaid coverage to approximately 30,000 uninsured poor adults from a recruited waiting list of almost 90,000.
Since the ACA's major coverage provisions took effect in 2014, states that expanded Medicaid have made far more progress in increasing health coverage rates than states that did not. In expansion states, the uninsured rate among low-income, non-elderly adults fell by more than half between 2013 and 2022, from 35% to 15%. In non-expansion states, it dropped only modestly, from 44% to 30%, leaving it twice the rate in expansion states.
As of February 2014, 25 states indicated they would not participate in Medicaid expansion. However, the Congressional Budget Office anticipates that most states will eventually participate in Medicaid expansion despite initially declining. South Dakota and North Carolina are the most recent states to adopt Medicaid expansion.
Medicaid expansion has been shown to have positive impacts on health outcomes. States that expanded Medicaid have dramatically lowered their uninsured rates. Research shows that Medicaid eligibility during childhood is associated with positive effects on health, including reduced avoidable hospitalizations and mortality. State Medicaid expansions to low-income adults are associated with increased access to care, increased economic security, improved self-reported health status, and other outcomes including increased early-stage cancer diagnosis rates and lower mortality rates for certain conditions.
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Medicaid beneficiaries have better access to care
Medicaid is a joint federal and state program that helps cover medical costs for certain low-income people, families and children, pregnant women, the elderly, and people with disabilities. Medicaid offers benefits not normally covered by Medicare, like nursing home care and personal care services. The rules around who is eligible for Medicaid differ from state to state. Generally, one must meet the state's rules for income and resources, and other rules (like being a resident of the state).
Research has shown that Medicaid eligibility during childhood is associated with positive effects on health (including reduced avoidable hospitalizations and mortality) and impacts beyond health, such as improved long-run educational attainment. State Medicaid expansions to low-income adults are associated with increased access to care, increased economic security, improved self-reported health status, and other outcomes including increased early-stage cancer diagnosis rates and lower mortality rates for certain conditions.
Medicaid covers 41% of all births in the United States, nearly half of children with special health care needs, 5 in 8 nursing home residents, 29% of non-elderly adults with any mental illness, and 40% of non-elderly adults with HIV. It is a key source of coverage for individuals experiencing homelessness and those transitioning out of carceral settings, particularly in states that have adopted the Medicaid expansion.
While Medicaid beneficiaries have better access to care than the uninsured, there are still gaps in access to certain providers (e.g., psychiatrists and dentists). These gaps may reflect system-wide problems, but they may be exacerbated by provider shortages in low-income communities, Medicaid’s lower physician payment rates, and lower Medicaid physician participation compared with private insurance.
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