Medicaid is both federal and state, which is why the program works differently depending on where you live

Medicaid is not run by one federal office. The federal government creates the rules and pays a share of the cost, but each state runs its own Medicaid program and decides who gets coverage within those federal rules. This split means your income limit, what services are covered, and how fast you hear back after you apply all depend on your state — not on Washington.

The federal government sets a floor: states must cover certain groups (pregnant people, children under 19, parents in some cases, and people over 65 or with disabilities who meet income thresholds). States can cover more people and more services if they choose to spend their own money. Some states have expanded Medicaid to cover adults earning up to 138% of the federal poverty line; others have not.

Because of this structure, you cannot call a national Medicaid number and get a single answer about your situation. You have to contact your state's Medicaid agency, which may be called the Department of Health and Human Services, Department of Social Services, or something else depending on where you live.

Key Takeaways

  • The federal government funds Medicaid and sets minimum rules, but each state operates its own program with its own income limits and covered services.
  • Your state's Medicaid program is the only one that can tell you whether you meet the requirements in your state, because those requirements vary.
  • Some states have expanded Medicaid to cover more adults; others have not, which creates significant differences in who can get coverage.
  • You apply through your state's Medicaid agency, not through a federal office, and processing times and required documents differ by state.
  • Federal law requires states to cover certain groups, but states can add coverage for other groups using their own funds.

Who funds Medicaid and who makes the rules

The federal government pays between 50% and 76% of Medicaid costs, depending on the state's average income. Wealthier states pay a larger share of their own Medicaid costs; poorer states receive more federal money. This is why the federal government has leverage to set rules — if a state wants federal dollars, it has to follow federal requirements.

But the federal government does not run the day-to-day program. Your state does. Your state decides how much paperwork you need to submit, how long you have to wait for a decision, whether a caseworker will call you to verify information, and what happens if you miss a deadline. Your state also decides whether to expand coverage beyond what federal law requires.

This is why two people with identical incomes and family situations can have very different Medicaid outcomes depending on which state they live in. One state might cover them; another might not.

How state Medicaid programs differ from each other

Income limits vary significantly. Federal law requires states to cover children under 19 whose family income is at least 133% of the federal poverty line (about $3,900 per month for a family of four in 2024, though this figure changes yearly). But states can set higher limits. Some states cover children in families earning up to 200% or 300% of poverty. Others stop at 133%.

For adults, the differences are even larger. Federal law does not require states to cover working-age adults without children or disabilities. States that have expanded Medicaid cover adults earning up to 138% of poverty. States that have not expanded cover almost no working-age adults. This means a single adult earning $1,500 per month might have Medicaid in one state and no coverage in another.

Services covered also differ. Federal law requires states to cover certain basics: hospital care, doctor visits, lab work, X-rays, and nursing home care for people over 21. But states decide whether to cover dental work, vision care, hearing aids, mental health treatment beyond crisis care, and many other services. Some states cover all of these; others cover none.

How to find out what your state's Medicaid program covers

Start by finding your state's Medicaid agency. Search "[your state name] Medicaid" or "[your state name] Department of Social Services" to find the official website. Each state's site has an income calculator or a list of income limits by household size and category (children, pregnant people, parents, elderly, disabled).

You can also call your state's Medicaid hotline — the number is on the state website — and ask whether you meet the income limit for your situation. Have your household size and monthly income ready. The person on the phone can tell you in minutes whether you are within range.

If you are not sure whether your state has expanded Medicaid, the Kaiser Family Foundation maintains a map showing which states have and have not expanded. This matters most if you are a working-age adult without children or disabilities, because expansion determines whether you have any path to Medicaid at all in your state.

What the federal government requires all states to do

Every state must cover children under 19 whose family income is below a certain threshold (at least 133% of poverty, though most states go higher). Every state must cover pregnant people and parents of children under 19 up to a certain income level. Every state must cover people over 65 and people with disabilities who meet income and asset limits.

Every state must process your information within a set timeframe — usually 45 days, though some states can take longer if they need more documents from you. Every state must tell you in writing whether you were approved, denied, or need more information.

Every state must allow you to report changes in income, family size, or address, and must update your coverage accordingly. Every state must provide an appeal process if you are denied or your coverage is ended.

But how each state carries out these requirements — the forms they use, the documents they ask for, the time it actually takes, whether they call you or make you call them — varies widely.

Federal Medicaid expansion and what it means for you

In 2014, the federal government offered states extra money to expand Medicaid to cover adults earning up to 138% of the federal poverty line. The federal government paid 100% of the cost for the first three years, then gradually reduced that to 90% by 2020. As of 2024, 39 states and Washington D.C. have taken this expansion. Eleven states have not.

If you live in an expansion state and you are a working-age adult without children or disabilities, you may have a path to Medicaid based on income alone. If you live in a non-expansion state, you generally cannot get Medicaid unless you are a parent, pregnant, elderly, or disabled.

This is one of the largest differences in Medicaid coverage across the country. It is not a difference in how the program is run — it is a difference in who the program covers at all.

How to contact your state's Medicaid program

You cannot apply for Medicaid through a federal website or phone number. You must contact your state. Search for "[your state name] Medicaid" to find the official state website, which will have an application link, a phone number, and information about income limits and required documents.

Many states also allow you to apply through your county social services office in person. Some states have partnered with community organizations to help people apply. You can ask 211 (dial 2-1-1 or visit 211.org) for the application location nearest you.

When you contact your state, have ready: your Social Security number, proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of citizenship or immigration status, and proof of where you live. Your state will tell you exactly what documents it needs.

Frequently Asked Questions

Can I apply for Medicaid in a different state than where I live?

No. You must apply through the state where you currently live. If you move to a new state, you will need to apply to that state's Medicaid program. Some states will end your coverage when you move; others will give you time to apply in your new state before they close your case.

Does the federal government pay for all Medicaid services?

No. The federal government pays a percentage of the cost (50% to 76% depending on the state), and the state pays the rest. This is why states sometimes cut services or tighten income limits when their budgets are tight — they are paying out of state funds, not federal funds.

If I move from a non-expansion state to an expansion state, will I automatically get Medicaid?

No. You will need to apply to your new state's Medicaid program. Your old state's coverage will end when you move. Once you apply in your new state, you may be found to meet the income limit under the expansion rules, but you have to apply first.

Why do some states cover more people than others if Medicaid is federal?

Because federal law sets a minimum — states must cover certain groups — but allows states to cover more people if they choose to spend their own money. Expansion states chose to cover more adults; non-expansion states chose not to. Both are legal under federal law.

Can the federal government force a state to change its Medicaid income limits?

The federal government can set conditions on federal funding, but it cannot force a state to spend state money on Medicaid. This is why non-expansion states have not expanded Medicaid even though the federal government initially offered to pay most of the cost — they chose not to spend their own money on it.