Medicaid covers hospital care, doctor visits, and prescription drugs, but what you get depends on which state you live in and which Medicaid program you're in

Medicaid is not one program — it is a joint federal and state system, which means your state decides what services to cover within federal minimums. Every state must cover hospital inpatient and outpatient care, doctor visits, lab work, X-rays, and nursing home care for people over 21. Most states also cover prescription drugs, mental health services, and dental care, but the scope, copayments, and limits vary. Some states cover vision care and hearing aids; others do not. Your state's Medicaid program publishes its own coverage list, called a State Plan or Summary of Benefits, and you can find it on your state Medicaid website.

Who can get Medicaid also varies by state. Federal law sets a floor — your state must cover certain groups like children under 19, pregnant people, parents of dependent children, and people over 65 with very low income. But states can and do cover additional groups: working adults without children, people with disabilities, people with specific medical conditions, and people with income above the federal minimum. Thirty-eight states have expanded Medicaid to cover adults earning up to 138 percent of the federal poverty line; twelve have not. That single difference means a 40-year-old with no children earning $1,500 a month might get Medicaid in one state and be ineligible in another.

Key Takeaways

  • Medicaid coverage varies significantly by state — what is covered in one state may not be covered in another, and income limits differ.
  • Every state covers hospital care, doctor visits, and lab work, but prescription drugs, dental care, and mental health services depend on your state's plan.
  • Your state's Medicaid website publishes its coverage list and income limits, which is the only authoritative source for what applies to you.
  • Medicaid for working-age adults without disabilities exists in 38 states but not in 12, so your state of residence determines whether you can get it at all.
  • You must meet both income and resource limits, and these thresholds change yearly and differ by family size and household composition.

Income and resource limits that determine whether you can get Medicaid

Medicaid has income limits, but the number depends on your state, your age, your family size, and whether you are pregnant, disabled, or a parent. For example, in 2024, a single adult in a Medicaid expansion state might have an income limit around $1,500 per month, while a parent in a non-expansion state might have a limit around $900. A pregnant person or child might have a higher limit than an adult. Your state Medicaid office publishes its current income limits on its website, usually in a table organized by household size and category.

Medicaid also counts your resources — money in the bank, property you own, vehicles, and other assets. Most states have a resource limit of $2,000 for an individual and $3,000 for a couple, though some states have higher limits or no limit at all. Your primary home and one vehicle usually do not count. If you are over 65 or blind or disabled, some states use different resource rules. You will need to report your income and resources when you apply, and your state will tell you whether you are within the limits.

Covered services in most states

Every state Medicaid program covers inpatient hospital care, outpatient hospital services, physician services, laboratory and X-ray services, and skilled nursing facility care for people over 21. This means if you need surgery, an emergency room visit, a doctor's appointment, blood work, or a stay in a nursing home, Medicaid will pay for it in every state. The copayment or coinsurance you pay (if any) varies by state and by service.

Most states also cover prescription drugs through their Medicaid pharmacy benefit, though the list of covered drugs (called a formulary) and any prior authorization requirements vary. Mental health services, including therapy and psychiatry, are covered in most states. Dental care is covered in most states for children and pregnant people, but coverage for adults is optional and varies widely — some states cover only emergency dental care, others cover routine cleanings and fillings. Vision care and hearing aids are optional benefits, so coverage depends on your state.

Services that vary by state or are optional

Medicaid programs can cover services beyond the federal minimum, and many do. These optional services include dental care for adults, vision care, hearing aids, physical therapy, occupational therapy, speech therapy, home health care, hospice, and transportation to medical appointments. Some states cover all of these; others cover a few; some cover none. If a service matters to you, check your state's Medicaid website or call your state Medicaid office to ask whether it is covered.

Long-term services and supports — nursing home care, assisted living, and in-home care for people who need help with daily activities — are covered by Medicaid in every state, but the rules about how much you can own, how much your spouse can keep, and how much you must spend down before Medicaid pays are complex and vary by state. If you think you might need long-term care, speak with your state Medicaid office or a legal aid organization about planning.

How Medicaid coverage changes if you are pregnant, disabled, or over 65

Pregnant people have higher income limits than other adults in most states, and Medicaid covers pregnancy-related care, delivery, and postpartum care for up to 60 days after the birth. Some states have extended this to 12 months. Children born to a Medicaid-covered pregnant person are automatically covered for the first year of life in most states.

People who are blind, disabled, or over 65 may have different income and resource limits than working-age adults. Some states use a higher income threshold for these groups. If you receive Supplemental Security Income (SSI) from Social Security, you are automatically covered by Medicaid in most states. If you receive Social Security Disability Insurance (SSDI), you may be covered depending on your state and your income.

How to find out what your state covers

Your state Medicaid program publishes its coverage rules in a document called the State Plan or Summary of Benefits. You can find this on your state's Medicaid website, which you can locate by searching "[your state] Medicaid" or by visiting Medicaid.gov and clicking your state. The state website will also show current income limits, resource limits, and the list of covered services. If you cannot find what you need online, call your state Medicaid office — the phone number is on the website — and ask a caseworker directly.

If you are already enrolled in Medicaid, your state sends you a member handbook or summary of benefits that explains what is covered under your specific plan. Read this document or call the number on your Medicaid card if you have questions about a specific service.

Medicaid managed care versus fee-for-service

Some states deliver Medicaid through managed care organizations (MCOs) — private insurance companies that contract with the state to cover Medicaid members. Others use fee-for-service, where the state pays doctors and hospitals directly. In managed care, you choose or are assigned to a plan, and that plan coordinates your care and decides which doctors and hospitals you can use. In fee-for-service, you can usually see any doctor or hospital that accepts Medicaid. Coverage is the same either way — your state decides what is covered — but the experience of using it differs. Your state Medicaid website will tell you whether your area uses managed care or fee-for-service.

If you are in a managed care plan, your plan's member handbook lists which doctors, hospitals, and pharmacies are in-network. Using in-network providers usually costs you less or nothing. Using out-of-network providers may cost more or may not be covered at all, depending on the plan and the service. If you need a specialist or a specific service, check your plan's website or call the number on your Medicaid card to confirm it is covered before you go.

Frequently Asked Questions

Does Medicaid cover dental work for adults?

Dental coverage for adults is optional, so it depends on your state. Some states cover routine cleanings, fillings, and extractions. Others cover only emergency dental care. A few cover nothing. Check your state Medicaid website or call your state Medicaid office to ask what is covered where you live.

Will Medicaid pay for my prescription medications?

Most states cover prescription drugs through Medicaid, but the specific drugs covered depend on your state's formulary. Some drugs may require prior authorization from your doctor. Call your state Medicaid office or check your member handbook to see whether a specific medication is covered.

If I move to a different state, does my Medicaid coverage move with me?

No. Medicaid is state-based, so when you move, your old state's coverage ends and you must apply in your new state. Your new state may have different income limits, resource limits, and covered services. You should apply as soon as you move to avoid a gap in coverage.

Does Medicaid cover mental health services?

Most states cover mental health services including therapy, psychiatry, and medication management through Medicaid. Some states limit the number of visits per year or require prior authorization. Check your state's Medicaid website or your member handbook to see what mental health services are available to you.

Can I get Medicaid if I have a job?

Yes, if your income is below your state's limit. In Medicaid expansion states, working adults can earn up to roughly 138 percent of the federal poverty line and still be covered. In non-expansion states, the limit is lower and usually applies only to parents or people with disabilities. Your state Medicaid website shows the current income limit for your situation.