Medicaid is a joint federal and state program, not a single national system

The most important thing to understand about Medicaid is that it is not one program run the same way everywhere. The federal government sets a floor — basic rules that all states must follow — but each state designs its own program within those rules. This means may be able to access thresholds, covered services, and how you apply differ significantly depending on where you live.

For example, a single adult with no children might be covered under Medicaid in New York but not in Texas, even if their income is identical. The same procedure might be covered in one state and not in another. This is not a bug in the system; it is how Medicaid was structured when Congress created it in 1965, and it remains true today.

Because of this structure, you cannot get a true answer to "Am I covered?" without knowing your state. Your state Medicaid agency — not a federal office — is the body that makes the actual decision about your coverage.

Key Takeaways

  • Medicaid rules vary by state, so your may be able to access depends on where you live, not on a single national standard.
  • States can choose to expand Medicaid to cover more people, and about half have done so; the other half have not.
  • Medicaid covers more than just doctor visits — it typically includes hospital care, prescription drugs, mental health services, and long-term care, though what is covered varies by state.
  • You must apply through your state Medicaid agency or a local office, not through a federal program.
  • Income limits exist, but they are set by each state and change year to year based on federal poverty guidelines.

Income limits are set by state and change annually

Medicaid has an income threshold, but it is not the same everywhere. The federal government publishes the Federal Poverty Level each year, and states use that as a starting point. Most states cover people at or below a certain percentage of that level — often 100% to 138% of the Federal Poverty Level, though some states go higher and some lower.

In 2024, the Federal Poverty Level for a single adult is around $14,600 per year, but your state's Medicaid program might cover people earning up to $20,000 or might only cover those earning under $10,000. You need to check your specific state's rules, because the number changes every January when the federal poverty guidelines update.

Income is also calculated differently depending on your household situation. If you have dependents, your household income is counted differently than if you are single. Some states count only earned income; others count unearned income like Social Security or child support. The only way to know whether your income qualifies is to look at your state's current guidelines or contact your state Medicaid office.

Medicaid expansion happened in some states but not others

In 2014, the Affordable Care Act allowed states to expand Medicaid to cover more people — specifically, adults earning up to 138% of the Federal Poverty Level who previously would not have may have access to. States could choose to do this or not. About 38 states and Washington, D.C. have expanded Medicaid; about 12 states have not.

If you live in an expansion state and you are an adult without dependent children, you may be covered even if you have no children and no disability. If you live in a non-expansion state, you may only be covered if you are pregnant, a parent of a dependent child, elderly, or disabled. This is one of the largest differences in who can get Medicaid depending on where you live.

You can find out whether your state has expanded Medicaid by contacting your state Medicaid office or checking your state's health department website. This status does not change often, but it is worth confirming because it directly affects whether you are even in the pool of people your state will consider.

Medicaid covers far more than just doctor visits

A common misunderstanding is that Medicaid only pays for emergency room visits or basic primary care. In reality, Medicaid typically covers hospital inpatient care, outpatient surgery, prescription medications, mental health and substance use treatment, dental care (in some states), vision care (in some states), and long-term care including nursing homes and home health services.

The catch is that what is covered varies by state. Every state must cover certain core services — like hospital care and doctor visits — but states can choose whether to cover things like dental work, vision care, or hearing aids. Some states cover all of these; others cover none. If a service matters to you, you need to check what your state's Medicaid program actually covers, not assume it is covered everywhere.

Medicaid also covers services that private insurance often does not, particularly long-term care. If you need to live in a nursing home or receive ongoing home health services, Medicaid may pay for that, whereas most private insurance will not. This is one reason Medicaid is often the only realistic option for people facing long-term care costs.

You must apply through your state, not through a federal office

There is no national Medicaid application. You apply through your state Medicaid agency, which may be called the Department of Human Services, Department of Social Services, Department of Health and Human Services, or something similar depending on your state. Some states let you apply online; others require you to apply in person or by mail.

Many states also allow you to apply through a local office — a county social services office, a community health center, or a hospital. Some states use a third-party contractor to process applications. The point is: you cannot call a federal number and apply for Medicaid. You must go through your state's system.

If you are not sure where to apply in your state, start by searching "[your state name] Medicaid" or calling your state health department. They can tell you the correct office and whether you can apply online. Some states also have a 211 line that can direct you to local Medicaid offices.

Medicaid is means-tested, so your assets and income both matter

Medicaid is not just about income; it is also about assets. You can have some savings and still be covered, but there are limits. For most Medicaid programs, the asset limit is around $2,000 for a single person and $3,000 for a couple, though this varies by state and by the type of Medicaid program you are applying for.

Assets typically include cash, bank accounts, and investments. A home you live in and one vehicle are usually not counted. If you are over the asset limit, you may not be covered, even if your income is low enough. This is different from many other programs and is one reason people sometimes have to spend down savings before Medicaid will cover them.

Asset rules are particularly strict for long-term care Medicaid — the program that pays for nursing home care. If you are applying for that, the asset limits are the same, but the rules about what counts as an asset are more detailed. You should speak with your state Medicaid office or a legal aid attorney if you are considering long-term care and have significant assets.

Medicaid is not the same as Medicare, and they serve different populations

A widespread source of confusion: Medicaid and Medicare are two separate programs with different rules, different funding, and different purposes. Medicare is a federal program for people 65 and older, regardless of income, and for some younger people with disabilities or end-stage renal disease. Medicaid is for people with low income, regardless of age.

You can be on both — this is called "dual may be able to access" — but being on one does not automatically put you on the other. Medicare is run by the federal government through the Centers for Medicare and Medicaid Services. Medicaid is run by states. They have different application processes, different covered services, and different rules about cost-sharing.

If you are 65 or older, you are likely may be able to access for Medicare based on your age and work history, not on income. If you are under 65 and have low income, you may be may be able to access for Medicaid. If you are both 65 and have low income, you may be on both programs, and they coordinate to pay for your care.

Frequently Asked Questions

Is Medicaid the same in every state?

No. While all states must follow federal rules, each state sets its own income limits, decides which services to cover beyond the federal minimum, and runs its own application process. Your coverage depends on your state.

Can I have a job and still be on Medicaid?

Yes. Medicaid is based on income, not employment status. If your job pays below your state's Medicaid income limit, you can be covered. Some states also have work incentive programs that let you keep Medicaid even if your income rises slightly.

What happens to my Medicaid if I move to a different state?

Your coverage ends in your old state. You must apply in your new state, and your may be able to access may change because income limits and covered services differ. Contact your new state's Medicaid office as soon as you move.

Does Medicaid cover prescription drugs?

Most states' Medicaid programs cover prescription medications, but the specific drugs covered and any cost-sharing vary by state. Some states have restrictions on which drugs are covered or require prior approval from the state before a drug is paid for.

Can I be denied Medicaid because I have too much money in the bank?

Yes. Medicaid has asset limits — usually around $2,000 for a single person — and if your savings exceed that, you may not be covered, even if your income is low. Asset rules are stricter for long-term care programs.