What Is Medicaid? Eligibility, Coverage, and How to Apply
Last updated 05/07/2026 by
Ante Mazalin
Edited by
Andrew Latham
Summary:
Medicaid is a joint federal and state health insurance program that provides free or low-cost coverage to eligible low-income individuals, families, children, pregnant women, seniors, and people with disabilities.
It is the largest source of health coverage in the United States, covering more than 80 million people.
- Eligibility: Based primarily on income relative to the federal poverty level (FPL), with rules varying by state and eligibility category.
- Coverage: Includes doctor visits, hospital care, prescription drugs, mental health services, and long-term care, often with no premiums or copays for the lowest-income enrollees.
- Administration: Each state runs its own Medicaid program within federal guidelines, so benefits and eligibility thresholds differ significantly by state.
For many Americans, Medicaid is the only path to affordable health coverage.
Whether you are evaluating options during a job loss, caring for an aging parent, or helping a child enroll, understanding how Medicaid works in your state is the essential first step.
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What Is Medicaid?
Medicaid was established in 1965 under Title XIX of the Social Security Act, alongside Medicare. The federal government sets minimum requirements and funds a portion of program costs through the Federal Medical Assistance Percentage (FMAP), which varies by state based on per capita income. States fund the remainder and administer the program.
According to the Centers for Medicare and Medicaid Services, Medicaid covers more than 80 million Americans, making it the largest single health coverage program in the country by enrollment.
Who Qualifies for Medicaid?
Eligibility depends on your state, income, household size, and category.
The Affordable Care Act (ACA) expanded Medicaid eligibility to adults with incomes up to 138% of the federal poverty level in states that adopted the expansion, but not all states have done so.
| Eligibility Category | General Income Threshold | Notes |
|---|---|---|
| Children | Up to 133% to 200%+ FPL | CHIP covers children in households above standard Medicaid limits in most states |
| Pregnant women | Up to 133% to 200% FPL | Many states extend higher income limits for pregnancy coverage |
| Adults (ACA expansion states) | Up to 138% FPL | Covers non-disabled adults without dependents; not available in all states |
| Seniors (65+) | Varies by state | Low-income Medicare enrollees may qualify for Medicaid dual coverage |
| People with disabilities | Varies; SSI eligibility often qualifies | SSI recipients are typically automatically eligible in most states |
What Medicaid Covers
Federal law requires all state Medicaid programs to cover certain mandatory services. States may also offer optional services beyond the federal floor.
- Mandatory services: Inpatient and outpatient hospital care, physician services, laboratory and X-ray services, family planning, and nursing facility care for adults.
- Optional services (offered by most states): Prescription drugs, dental care, vision services, physical therapy, and home health services.
- Long-term care: Medicaid is the primary payer for nursing home and home-based long-term care in the U.S., covering costs that Medicare does not pay beyond 100 days.
Pro Tip
If you are enrolled in both Medicare and Medicaid (called “dual eligible”), Medicaid can cover Medicare premiums, deductibles, and copays that would otherwise come out of pocket. This coordination of benefits can eliminate most out-of-pocket healthcare costs for low-income seniors. Contact your state Medicaid office or a Medicare counselor to confirm whether you qualify for a Medicare Savings Program.
Medicaid vs. Medicare
Medicaid and Medicare are both government health programs, but they serve different populations and operate under different rules.
| Feature | Medicaid | Medicare |
|---|---|---|
| Who it covers | Low-income individuals and families | Adults 65+ and certain disabled individuals under 65 |
| Eligibility basis | Income and category | Age or disability, regardless of income |
| Administered by | States, within federal guidelines | Federal government (CMS) |
| Premiums | None or very low for most enrollees | Monthly premiums for Parts B and D |
| Long-term care | Covers nursing home and home care extensively | Limited to 100 days of skilled nursing after hospitalization |
Medicaid Expansion Under the ACA
The Affordable Care Act gave states the option to expand Medicaid to cover adults up to 138% of the federal poverty level. As of 2025, 40 states and Washington D.C. have adopted the expansion.
In non-expansion states, low-income adults without children or disabilities often fall into a coverage gap: their incomes are too high for traditional Medicaid but too low to qualify for ACA marketplace subsidies. Residents of non-expansion states should check their state’s specific eligibility rules and local assistance programs.
Good to know: Medicaid enrollment is open year-round. Unlike marketplace health plans, there is no open enrollment period for Medicaid. If your income drops, you have a baby, or another life change occurs, you can apply and enroll immediately if eligible.
Medicaid and Long-Term Care Planning
Nursing home care can cost $80,000 to $100,000 or more per year. Medicare covers only the first 100 days after a qualifying hospital stay, leaving Medicaid as the primary payer for millions of Americans who exhaust their savings.
To qualify for Medicaid long-term care benefits, applicants typically must spend down most of their assets. Medicaid has a five-year “look-back” period during which transfers of assets are reviewed. Gifts or transfers made within five years of applying can result in a penalty period during which Medicaid coverage is delayed.
Planning ahead with long-term care insurance can preserve assets and provide more flexibility than Medicaid’s means-tested approach.
How to Apply for Medicaid
Applications are submitted through your state’s Medicaid agency or through the federal Health Insurance Marketplace at healthcare.gov. Most states allow online, phone, mail, or in-person applications.
You will need to provide proof of identity, residency, income, and household size. Eligibility decisions are typically made within 45 days for most applicants and within 90 days for disability-based applications.
Related reading on health coverage
- Health insurance: how health insurance plans are structured and how Medicaid fits within the broader coverage landscape.
- Health Savings Account (HSA): a tax-advantaged account available to those enrolled in high-deductible plans outside of Medicaid.
- Disability insurance: how private disability coverage works alongside or in place of Medicaid disability benefits.
- Financial aid: how Medicaid enrollment interacts with other need-based assistance programs.
Frequently Asked Questions
What is the income limit for Medicaid?
Income limits vary by state and eligibility category. In ACA expansion states, adults can generally qualify with incomes up to 138% of the federal poverty level (about $20,700 for an individual in 2025). Children and pregnant women often qualify at higher income thresholds. Non-expansion states have more restrictive rules, particularly for adults without children.
Is Medicaid the same as Medicare?
No. Medicare is a federal health program for adults 65 and older and certain younger people with disabilities, regardless of income. Medicaid is a joint federal-state program for low-income individuals of any age. Some people qualify for both programs simultaneously, known as dual eligibility.
Does Medicaid cover dental and vision?
Federal law requires dental coverage for children under Medicaid, but adult dental coverage is optional and varies significantly by state. Vision coverage for adults is also optional. Check your state’s Medicaid program for the specific services covered in your plan.
Can I have both Medicaid and private insurance?
Yes. If you have both Medicaid and private insurance, the private insurance pays first as the primary payer, and Medicaid may pay remaining cost-sharing as a secondary payer. This is common for individuals who gain employer coverage mid-year while remaining eligible for Medicaid.
What happens to my Medicaid if my income increases?
You are required to report income changes to your state Medicaid agency. If your income rises above the eligibility threshold, your coverage will end at the close of your current coverage period. You may then be eligible for subsidized marketplace coverage through the ACA, and a special enrollment period is triggered by the loss of Medicaid coverage.
Key takeaways
- Medicaid is a joint federal-state program covering more than 80 million low-income Americans, including children, families, seniors, and people with disabilities.
- Eligibility is based on income relative to the federal poverty level, with rules varying significantly by state.
- 40 states have expanded Medicaid under the ACA to cover adults up to 138% FPL; non-expansion states have more restrictive rules.
- Medicaid is the primary payer for long-term nursing home care in the U.S., subject to asset limits and a five-year look-back period.
- Enrollment is open year-round; apply through your state Medicaid agency or at healthcare.gov.
If you are comparing health coverage options, including Medicaid alternatives for those near income thresholds, review health insurance plans on SuperMoney to see your options side by side.
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