What Is Medicaid?

“People tend to use the terms interchangeably, but they are not at all the same,” says Josh Hodges, the chief customer officer at the National Council on Aging.

Unlike Medicare, which is funded by the federal government and is primarily for people age 65 and older, Medicaid is jointly funded by both the state and federal government. That means each state determines who qualifies, which nonmandatory services are covered, and how care is delivered.

• Doctors’ visits and hospital care
• Preventive care like checkups and vaccines
• Lab tests and X-rays
• Prenatal and maternity care
• Prescription drugs
• Mental health services
• Transportation to medical appointments
• Emergency services

• Eligibility rules
• Application processes
• Additional services such as dental care and physical therapy
• Provider reimbursement rates

Medicaid provides free or low-cost health coverage to millions of Americans with diverse needs. Here’s who may be eligible.

Financial Eligibility

Medical Eligibility

If you have very expensive medical bills, but your income is higher than the Medicaid requirements, you may still qualify for the program if your healthcare expenses exceed a certain amount, called the medically needy income limit.

Special Circumstances Eligibility

While Medicaid is often discussed as a single program, there are, in fact, different types, each of which provides coverage through different pathways.

• Traditional Medicaid This program exists in every state, plus DC and all U.S. territories. It covers children, pregnant women, parents with dependents, adults 65 and older, and people with disabilities based on their income and household size.

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• Expansion Medicaid This program covers adults under the age of 65 in 40 states and DC who have an income that’s no more than 138 percent of the Federal Poverty Level.

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  In 2025, that amount is $21,597 annually for a single person and $44,367 for a household of four.
• Long-Term Care Medicaid Even though more than 60 percent of all nursing home residents are covered by Medicaid, most Americans are unaware that Medicaid covers this type of care.

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  Beyond nursing homes, Medicaid helps pay for home care and other extended care needs, known as long-term services and supports (LTSS).

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   These services assist people who need help with daily activities like eating or bathing. While all states cover nursing home care for those who meet income and asset requirements, home and community-based service coverage varies by state.

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You can determine your eligibility for Medicaid by entering your state and household size on HealthCare.gov or contacting your state Medicaid agency directly.

• State Medicaid Agency Apply online, by phone, or in person in your state’s Medicaid office.
• Healthcare.gov Go to Healthcare.gov to apply. If you qualify, your application will be forwarded to your state Medicaid agency.
• Automatic Enrollment In 34 states and DC, SSI recipients are automatically enrolled.

For nursing home care and home-based care services (HCBS), Medicaid covers 100 percent of the costs — including rooming, meals, and medical supplies. But you’ll need to contribute nearly all your income toward these costs first, keeping only a small personal needs allowance (PNA), which varies by state.

“Individuals with Medicaid coverage are also eligible for ‘Extra Help,’ a Medicare program that reduces drug costs,” notes Kertesz.

• Understand why you lost coverage. States regularly check your eligibility for Medicaid. If your income (or other factors) make you ineligible, your coverage may end. If you’ve received a notice or request from your state, don’t ignore it — respond quickly to avoid losing coverage unnecessarily.
• Reapply for Medicaid. If you believe there was a mistake, reapply — you can do so anytime your income or circumstances change.
• Apply for Marketplace coverage. Plans on the Health Insurance Marketplace, a government-run platform for finding health insurance, offer low-cost options for those transitioning off Medicaid. You can apply up to 60 days before Medicaid ends or within 90 days after it ends, with coverage starting the next month.
• Get free help. Marketplace assisters can explain your health coverage options and help you apply for free. Visit HealthCare.gov to find local help or contact the Marketplace Call Center at 800-318-2596.

• Private health insurance
• Medicare
• Employer-sponsored plans
• Workers’ compensation
• Court-ordered health coverage
  

When you have Medicaid plus another form of health coverage, know that:

• Medicaid pays last. Medicaid acts as a secondary payer, covering what your other plan doesn’t, including copays, deductibles, or remaining balances. So if you’re on Medicare, too, “Medicaid will pick up your Medicare deductible and copays,” says Sandy Kemp, a registered Social Security analyst in Las Vegas.
• Medicaid coordinates with other coverage. If your other insurance is responsible for part of a medical bill, Medicaid works directly with that insurer to make sure your providers are paid.
• Drug coverage may shift. If you have both Medicare and Medicaid, you’ll be automatically enrolled in a Medicare drug plan that covers your medication costs instead of Medicaid.

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• Medicaid provides free or low-cost health coverage to millions of low-income individuals, families, seniors, and people with disabilities.
• Program eligibility and benefits vary by state, so it’s important to check with your state Medicaid office to understand what’s available to you.
• Medicaid covers essential services like doctor visits, hospital care, and preventive care, and may also help cover long-term care services for those who qualify.
• If you lose Medicaid coverage, you may qualify for low-cost health insurance through the Health Insurance Marketplace.