Medicaid

Key Takeaways

• Medicaid is a joint federal-state health insurance program for low-income individuals and families
• Coverage includes children, pregnant women, parents, seniors, and people with disabilities
• Eligibility and benefits vary by state
• Most states have expanded Medicaid under the ACA to cover adults with incomes up to 138% of poverty
• Use our Health Insurance Calculator to check your potential eligibility

What is Medicaid?

In plain English: Medicaid is a U.S. government health insurance program that provides free or low-cost medical coverage to people with limited income. It’s jointly funded by the federal government and states, but each state runs its own program, so eligibility and benefits vary by state.

Medicaid is the largest source of health coverage in the United States for low-income populations, providing essential health services to millions of Americans.

How Medicaid Works

Funding

Medicaid is funded jointly by the federal government and individual states. The federal government provides a matching percentage of each state’s Medicaid spending, with the match rate varying based on the state’s per capita income. Poorer states receive a higher federal match.

Administration

Each state administers its own Medicaid program within federal guidelines, determining eligibility criteria and covered services. This means Medicaid looks different in every state, with varying benefits and eligibility rules.

Plan Type	Provider Choice	Referral Needed?	Premium Level
HMO	In-network only	Yes	Lower
PPO	In & out of network	No	Higher
EPO	In-network only	No	Medium
POS	In & out of network	Yes for specialists	Medium

Covered Services

• Mandatory Services — Inpatient/outpatient hospital, physician, nursing facility, home health care.
• Optional Services — Prescription drugs, dental, vision, mental health, physical therapy.
• Long-Term Care — Nursing home care, home and community-based services.
• Early and Periodic Screening — Preventive care for children under EPSDT program.

Eligibility

Medicaid eligibility varies by state, but generally includes these groups:

• Children: Up to age 19 in households with income below certain thresholds
• Pregnant Women: Income-based eligibility, often with higher limits
• Parents/Caretakers: Low-income parents caring for children
• Seniors: Individuals aged 65+ with limited income and assets
• People with Disabilities: Individuals with permanent disabilities

Medicaid Expansion

The Affordable Care Act (ACA) authorized states to expand Medicaid eligibility to adults with incomes up to 138% of the federal poverty level. As of 2026, most states have adopted Medicaid expansion, providing coverage to millions of additional low-income adults who were previously ineligible.

Medicaid vs. Medicare

Medicaid is a joint federal-state program for low-income individuals of all ages, while Medicare is a federal program primarily for seniors aged 65+. Some individuals qualify for both programs (dual eligibility), with Medicaid covering costs not covered by Medicare.

Check Your Medicaid Eligibility

Curious if you or your family might qualify for Medicaid? Try our Health Insurance Calculator to estimate your eligibility based on income and family size.

Frequently Asked Questions (FAQ)

Q: How do I apply for Medicaid?

A: You can apply through your state’s Medicaid agency, through the Healthcare.gov marketplace, or by contacting your local social services office.

Q: Is Medicaid free?

A: For most low-income individuals, Medicaid has little to no cost. Some states may charge small premiums or copays for certain services, especially for individuals with higher incomes.

Q: Does Medicaid cover dental and vision?

A: Dental and vision coverage are optional services that vary by state. Some states provide comprehensive coverage, while others offer limited benefits or none at all.

Q: What if my state hasn’t expanded Medicaid?

A: If your state hasn’t expanded Medicaid and you don’t qualify for traditional Medicaid, you may still be eligible for premium tax credits through the ACA marketplace.

Authority Sources

• Medicaid.gov - Official U.S. government Medicaid website
• Centers for Medicare & Medicaid Services (CMS)
• U.S. Department of Health and Human Services (HHS)
• Healthcare.gov - ACA marketplace
• CMS (Centers for Medicare & Medicaid Services) - U.S. federal health programs
• IRS (Internal Revenue Service) - Health savings account rules and tax penalties
• HHS (U.S. Department of Health and Human Services) - Health insurance marketplace

Related Terms

Health Insurance ACA (Affordable Care Act) Copay Coinsurance Medicare