Medicaid covers medical care for people with low income, but the rules change by state and by what you need

Medicaid is a joint federal and state program, which means the federal government sets a floor of what must be covered, but each state runs its own program with its own income limits, covered services, and enrollment rules. A statement about Medicaid that is true in one state may not be true in another. Understanding which facts hold everywhere and which ones depend on where you live is the first step to knowing what your state's program actually covers.

The most common confusion comes from mixing up Medicaid with Medicare, or thinking Medicaid works the same way everywhere. It does not. What matters is learning what your specific state program covers, what the income cutoff is in your state right now, and whether you meet the other rules your state has set.

Key Takeaways

  • Medicaid income limits and covered services vary significantly by state, so a true statement about one state's program may not apply to yours.
  • Medicaid is not the same as Medicare; Medicare is for people 65 and older or with certain disabilities, while Medicaid is for people with low income.
  • All states must cover certain services like hospital care and doctor visits, but states can add or remove optional services like dental or vision care.
  • Your state's Medicaid program determines whether you can enroll, what you pay, and what services you receive — not a federal office.

What Medicaid must cover in every state

The federal government requires every state Medicaid program to cover a set of core services. These include inpatient hospital care, outpatient hospital services, emergency services, doctor visits, laboratory and X-ray services, and nursing facility care for people 21 and older. Every state also must cover family planning services and services for people under 21 that are needed to help them reach adulthood.

Beyond these required services, states can choose to cover additional things like dental care, vision care, hearing aids, or physical therapy. Some states cover all of these; others cover none. This is why two people with the same income and the same health need might have different coverage depending on which state they live in. Checking your state's specific list of covered services is the only way to know what you can actually use.

Income limits are set by each state, not by the federal government

The federal government sets a minimum income threshold — called the federal poverty level — but states can set their own limits higher or lower. Some states cover people up to 138 percent of the federal poverty level; others cover people at 100 percent or even lower. A few states have not expanded their Medicaid programs at all for adults without children, which means the income limit for a childless adult in those states is extremely low or the person does not may have access to at all.

Your state's income limit also depends on your household size and whether you have children. A single person might have a different income cutoff than a parent with two children in the same state. The only way to know whether you fall within your state's limit is to check with your state's Medicaid office or use your state's online screening tool. Income limits also change year to year, so what was true last year may not be true now.

Medicaid and Medicare are completely different programs

Medicare is a federal program for people 65 and older, regardless of income. It also covers some younger people with disabilities or end-stage renal disease. You pay into Medicare through payroll taxes during your working years, and it is the same in every state.

Medicaid is for people with low income, regardless of age. It is run by each state, so the rules are different everywhere. You do not pay into Medicaid through taxes; it is funded by federal and state tax dollars and is based on financial need. A person can have both Medicare and Medicaid at the same time — this is called "dual may be able to access" — but the two programs work separately and cover different things.

Common statements about Medicaid that are often wrong

"Medicaid covers everyone with low income" — This is not true. Income alone does not determine Medicaid coverage. You must also meet your state's other rules, which may include citizenship status, residency, age, disability status, or family composition. Some states have expanded Medicaid to cover more adults; others have not. Your state's specific rules determine whether you may have access to.

"Medicaid is free" — Medicaid itself does not charge a monthly premium in most states, but some states charge small copayments when you use services. A few states charge premiums for certain groups. "Free" is misleading because you still pay out of pocket when you use care, and coverage limits exist. Medicaid also does not cover everything — it covers only what your state has decided to cover.

"Once you are on Medicaid, you stay on Medicaid" — This is false. Medicaid coverage can end if your income rises above your state's limit, if you move to another state, if you do not recertify when your coverage period ends, or if your state changes its rules. Many people lose Medicaid without realizing it because they did not know they had to recertify or because their circumstances changed.

"Medicaid covers long-term care in nursing homes" — Medicaid does cover nursing facility care, but only under specific conditions. You must meet your state's medical need requirements, and your assets and income must fall within your state's limits. Medicaid also does not cover assisted living or most home care services in most states, even though many people assume it does.

How to find out what is true about your state's Medicaid program

Your state's Medicaid office is the only source that can tell you what your state's program actually covers and whether you meet your state's rules. You can find your state Medicaid office through your state's health department website or by calling 211, which is a free referral line that connects you to local programs.

Many states also have online screening tools where you can enter your income and household information and get an immediate answer about whether you may be covered. These tools do not make a final decision, but they give you a starting point. After screening, you will need to submit documents to your state's Medicaid office to confirm your information. The process usually takes two to four weeks, though some states are faster or slower.

Frequently Asked Questions

Is Medicaid the same in every state?

No. While all states must cover certain core services, each state sets its own income limits, decides which optional services to cover, and makes its own rules about who qualifies. A person who qualifies for Medicaid in one state may not may have access to in another, and coverage for the same service may differ between states.

Can I use Medicaid from one state if I move to another?

No. Medicaid is state-based, so your coverage ends when you move. You must apply for Medicaid in your new state using that state's rules and income limits. Some states process applications faster than others, so there may be a gap in coverage while you wait. Contact your new state's Medicaid office as soon as you move.

Does Medicaid cover dental and vision care?

It depends on your state. Some states cover dental and vision services for all Medicaid members; others cover them only for children; others do not cover them at all. Check your state's Medicaid website or call your state's Medicaid office to find out what your state covers.

What happens if my income goes up while I am on Medicaid?

If your income rises above your state's limit, you will lose Medicaid coverage. Your state's Medicaid office will notify you when this happens. Some people become ineligible for Medicaid but may may have access to for subsidized health insurance through the federal marketplace instead. Report income changes to your state's Medicaid office right away so there are no surprises.

Can I have both Medicaid and Medicare?

Yes. If you are 65 or older and have low income, you may may have access to for both. People with both programs are called "dual may be able to access." Medicare is your primary insurance, and Medicaid covers some costs that Medicare does not. Your state's Medicaid office can tell you whether you may have access to for both programs.