Medicaid is a joint federal and state health insurance program for people with low income

Medicaid is a government health insurance program that pays for medical care — doctor visits, hospital stays, prescription drugs, and other services — for people who meet income and other requirements. It is run together by the federal government and each state, which means the rules, what it covers, and who can join vary significantly depending on where you live.

Unlike Medicare, which is based on age or disability and is the same everywhere, Medicaid is means-tested: your income and assets matter. Each state sets its own income limits, decides which services to cover beyond the federal minimum, and runs its own enrollment process. This means a person who qualifies in one state may not may have access to in another, and what Medicaid pays for in your state may differ from what it pays for in a neighbouring state.

Medicaid is funded by federal tax dollars and state tax dollars combined. The federal government sets baseline requirements — who must be covered, what services must be offered — but states have flexibility in how they run their programs and what extra services they choose to cover.

Key Takeaways

  • Medicaid is a health insurance program for people with low income, run jointly by the federal government and your state, so rules and coverage differ by location.
  • Income limits, covered services, and enrollment processes are set by your state, not by a national office.
  • Medicaid covers doctor visits, hospital care, prescription drugs, and many other medical services, though what is covered varies by state.
  • You do not pay a monthly premium for Medicaid in most cases, though some states charge small copayments when you use services.
  • Each state has its own application process, usually through the state health department or a contracted enrollment agency.

Who Medicaid covers

Medicaid covers people in several categories. The largest group is children and adults with income below a certain threshold — that threshold is set by your state and is usually expressed as a percentage of the federal poverty line. A second group is pregnant people and parents of dependent children, though income limits for these groups vary widely by state. A third group is people aged 65 and older with low income. A fourth is people who are blind or disabled and meet income and asset limits.

Some states have expanded Medicaid to cover all adults with income up to 138 percent of the federal poverty line; others have not. This creates a coverage gap in states that have not expanded: people who earn too much for traditional Medicaid but too little to afford private insurance may have no coverage option through Medicaid. Whether your state has expanded Medicaid affects whether you can join.

Asset limits also matter in some states. Medicaid programs in some states count how much money and property you own, not just your income. Other states have removed asset limits entirely. You will need to know your state's specific rules when you apply.

What Medicaid covers

Federal law requires all state Medicaid programs to cover certain services: inpatient hospital care, outpatient hospital services, emergency services, doctor visits, laboratory and X-ray services, nursing facility care for people 21 and older, home health services, and family planning services. Prescription drugs are also required to be covered, though states can limit which drugs and how often you can refill them.

Beyond these required services, states can and do cover additional things. Many states cover dental care, vision care, mental health services, substance use treatment, and physical therapy. Some cover transportation to medical appointments. The list of what your state covers is published by your state Medicaid agency, and it is worth checking because coverage varies significantly.

Medicaid does not cover everything. Cosmetic procedures, most dental work (in states that do not cover it), and certain experimental treatments are typically not covered. Your state Medicaid program publishes a list of covered and non-covered services; you can ask before you receive care whether a specific service will be covered.

How much Medicaid costs

In most cases, you do not pay a monthly premium for Medicaid. This is one of the main differences between Medicaid and private health insurance. However, some states charge small monthly premiums for certain groups — usually working adults or people with higher income within the Medicaid range — so check your state's rules.

You may have to pay copayments when you use services. A copayment is a small fixed amount you pay at the time of care — for example, $3 for a doctor visit or $1 for a prescription. Copayments vary by state and by the type of service. Some states charge no copayments at all; others charge them for most services. Pregnant people, children, and people receiving emergency care are often exempt from copayments.

Medicaid does not charge deductibles the way private insurance does. You do not have to pay a large amount out of pocket before Medicaid starts paying. This makes Medicaid significantly cheaper than private insurance for people with low income.

How to apply for Medicaid in your state

The application process is run by your state. In most states, you apply through the state Medicaid agency or through a contracted enrollment organization. Many states now use a single online portal called a marketplace or exchange where you can apply for Medicaid and other programs at the same time.

You will need to provide proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of citizenship or immigration status, proof of residency in your state, and identification. Some states also ask for proof of assets. The exact documents required vary by state.

Application timelines vary. Some states process applications within two weeks; others take longer. Once you are approved, your coverage usually starts on the first day of the month following approval, though some states backdate coverage to the month you applied. You will receive a Medicaid card or a notice telling you how to access your coverage.

Medicaid and immigration status

Federal law restricts Medicaid to U.S. citizens and certain categories of immigrants. Lawful permanent residents (green card holders) are generally may be able to access. Refugees and asylees are may be able to access. Undocumented immigrants are not may be able to access for regular Medicaid in most states, though some states use their own funds to cover emergency services for undocumented people.

Some states have expanded coverage to include certain immigrant groups beyond what federal law requires. A few states cover undocumented young adults or undocumented seniors. If you are an immigrant, your state Medicaid agency can tell you whether you may have access to based on your immigration status.

Medicaid and other programs

Medicaid works alongside other assistance programs. If you receive Supplemental Security Income (SSI) for disability or age, you may automatically may have access to for Medicaid in your state. If you receive Temporary Assistance for Needy Families (TANF), you may may have access to. Some people may have access to for both Medicaid and Medicare — these people are called "dual may be able to access" and can use both programs together.

Medicaid also coordinates with the Affordable Care Act marketplace. If you do not may have access to for Medicaid but have low income, you may may have access to for subsidies to buy private insurance through the marketplace instead. The marketplace application process can help you figure out which program you may have access to for.

Frequently Asked Questions

Is Medicaid the same in every state?

No. While the federal government sets minimum requirements, each state decides its own income limits, which services to cover beyond the federal minimum, and how to run its program. A person who qualifies in one state may not may have access to in another, and coverage can differ significantly.

Can I have Medicaid and private insurance at the same time?

Yes. Some people have both. Medicaid will coordinate with your private insurance, paying for services the private plan does not cover or paying the copayments and deductibles your private plan requires. Tell your Medicaid program if you have other insurance.

What happens to my Medicaid if I get a job?

It depends on your income and your state's rules. If your income rises above your state's Medicaid limit, you will lose coverage. However, many states have "work incentives" that let you keep Medicaid for a period of time even after your income exceeds the limit, or that let you buy into Medicaid at a low cost. Ask your state Medicaid program about work incentives before you start a job.

How do I renew my Medicaid?

Medicaid requires periodic renewal, usually once a year. Your state will send you a notice telling you when to renew. You can renew online, by mail, or by phone in most states. You will need to provide updated income and household information. If you do not renew by the deadline, your coverage will end.

Can I use my Medicaid card in another state?

Medicaid is state-specific. If you move to another state, you will need to apply for that state's Medicaid program. Your coverage from your previous state will end. Some states process new applications quickly for people who have recently moved, so contact your new state's Medicaid program as soon as you arrive.