Medicaid is government health insurance for people with low income. It's the largest health insurance program in the country—over 90 million Americans rely on it. This guide walks you through eligibility, how to apply, what's covered, how to keep your coverage, what to do if you're denied, and how to protect your assets if you need long-term care.
What you'll learn: The basics, eligibility rules (MAGI vs. non-MAGI), application process, coverage details, renewals and work requirements, appeals and fair hearings, Home and Community-Based Services, asset protection strategies, and Medicare + Medicaid combinations.
Medicaid is government health insurance for people with low income. It's run jointly by the federal government and your state.
Medicaid is health insurance paid for by the government for people who can't afford private insurance. It covers doctor visits, hospital stays, prescriptions, and much more—often with zero copays or very small ones ($1–$4).
Unlike Medicare (which is for people 65+), Medicaid is based on your income. If your income is low enough, you can qualify regardless of age. And here's something most people don't realize: you can have both Medicare and Medicaid at the same time.
Every state runs its own Medicaid program, and many states call it something different. What matters: it's still Medicaid.
People confuse these two programs all the time. Here's the simple breakdown:
| Medicare | Medicaid | |
|---|---|---|
| Who qualifies | 65+ or disabled 24+ months | Low-income people of any age |
| Based on | Age / disability / work history | Income and assets |
| Who runs it | Federal government (same everywhere) | Federal + state (varies by state) |
| Cost to you | Part B: ~$203/mo premium | Usually free or $1–$4 copays |
| Nursing home | Limited (100 days max) | Covers long-term care |
| Dental/Vision | Usually not covered | Varies by state |
| Can have both? | Yes—called "dual eligible" | |
The bottom line: Medicare is about age and work history. Medicaid is about income. Many low-income seniors qualify for both, and that's actually the best position to be in—Medicaid fills in all the gaps Medicare leaves.
In 2012, the Supreme Court ruled that states could choose whether to expand Medicaid under the Affordable Care Act. This one decision created two different Americas for Medicaid access.
Expansion states (about 40 states + DC): Extended Medicaid to adults earning up to 138% of the federal poverty level—roughly $1,799/month for an individual in 2026. Working-age adults without disabilities can qualify.
Non-expansion states (about 10 states): Kept the old, much stricter rules. Working-age adults without disabilities often can't qualify no matter how poor they are. This creates a "coverage gap."
Medicaid eligibility depends on your income, assets, age, disability status, and where you live. There are multiple pathways—even if you think your income is too high, there may be a way in.
Medicaid has two different eligibility systems:
MAGI (Modified Adjusted Gross Income)—The simpler system. Uses tax-return-like income. Applies to: working-age adults, parents, pregnant people, children. No asset test. Used in expansion states for adults under 65.
Non-MAGI—The more complex system. Uses "countable income" with exclusions and disregards. Applies to: people 65+, blind, disabled. Has asset/resource limits ($2,000 individual / $3,000 couple).
Income limits vary by state, but here are the key benchmarks:
| Category | Individual | Couple |
|---|---|---|
| MAGI Adults (expansion) | $1,799/mo (138% FPL) | $2,432/mo |
| Aged/Blind/Disabled (non-MAGI) | ~$967/mo (SSI level) | ~$1,450/mo |
| Nursing Home (300% SSI) | $2,901/mo | See spousal rules |
| Pregnant (200% FPL) | ~$2,609/mo | — |
| Children under 19 | Up to 200-300% FPL (very generous) | |
2026 Federal Poverty Level: $15,650/year ($1,304/month) for an individual. Your state may be more generous than these federal minimums.
If you're applying under non-MAGI rules (65+, blind, or disabled), Medicaid looks at your "countable resources"—savings, investments, and assets.
2026 limits: $2,000 for an individual, $3,000 for a couple.
What does NOT count:
What DOES count: Bank accounts, savings, CDs, stocks, bonds, second properties, additional vehicles.
Here's something most people don't know: even if your income is above the Medicaid limit, you might still qualify through "spend-down."
Spend-down works like a deductible. You pay medical bills out of pocket until your remaining income drops below the Medicaid limit. Once you hit that threshold, Medicaid kicks in and covers the rest for that month.
Example: Your income is $2,500/month. Your state's Medicaid limit is $2,000. Your medical bills this month are $700. After spend-down: $2,500 − $700 = $1,800 (below the limit). Medicaid covers the rest.
This is especially valuable for people with high medical costs—cancer treatment, dialysis, nursing home care. Ask your state about "medically needy" pathways.
Medicaid Buy-In (Working Disabled): If you have a disability and want to work, the Medicaid Buy-In lets you keep coverage even if earnings go above the limit. You pay a small premium ($0–$50/month).
Immigrants and Non-Citizens: Green card holders qualify after 5 years. Refugees and asylees qualify immediately for up to 8 years. Emergency Medicaid covers anyone for true medical emergencies regardless of status. Applying for Medicaid does not trigger immigration enforcement—your information is confidential.
Presumptive Eligibility: In some situations (pregnancy, emergency care, nursing facility admission), you can get temporary Medicaid coverage immediately—before your full application is processed.
Applying for Medicaid can feel overwhelming, but it doesn't have to be. Here's exactly what to do, what documents to bring, and what to expect.
You can apply for Medicaid through several channels:
Gather these before you apply to speed things up:
Processing time: Typically 30–45 days (sometimes faster for online applications). Presumptive eligibility can get you coverage within days.
Once approved: Coverage often starts on the 1st of the month in which you applied (or the date approved, depending on your state). You'll get a Medicaid card in the mail within 2–3 weeks. Before it arrives, ask your state for a temporary eligibility number or confirmation letter to show doctors.
If you're denied: Don't panic. You have the right to appeal. Section 6 covers this in detail. Many people appeal and win because their first application was incomplete or the reviewer made an error.
If your circumstances change: Report changes in income, address, household, employment, or other factors within 30 days. Many states let you report online or by phone.
Medicaid covers far more than you might think. Here's what's included, what varies by state, and how to find your state's specific benefits.
These mandatory services are covered in all 50 states:
These services are optional—states can choose to cover them or not. Check your state's benefits:
Medicaid is designed to have minimal out-of-pocket costs:
No copays can be charged for emergency care, family planning, preventive services, or care for pregnant women. Copays are capped—usually 5% of cost or $4, whichever is lower.
Your state may give you a choice:
Fee-for-Service (FFS): You choose your doctor. Medicaid pays the doctor directly. You show your Medicaid card.
Managed Care: You choose or are assigned a plan (similar to an HMO or PPO). You pick a primary care doctor. The plan manages your care and has networks of doctors and hospitals.
Both are fine. Managed care often coordinates care better for people with chronic conditions. Fee-for-service gives you more choice. Ask your state which is available to you.
Medicaid is here as long as you qualify. But you need to renew your coverage and report life changes. Here's how to stay covered.
Medicaid coverage typically needs to be renewed once per year. Your state will send you a renewal notice, usually 30 days before your coverage expires.
How to renew:
What to do: Report any changes in income, household, employment, living situation, or contact information. Send it back promptly—if you miss the deadline and don't respond, your coverage can be terminated.
Some states have added work requirements for Medicaid beneficiaries under the "Observance of Benefit Benefit Balancing Act" (OBBBA) waiver. Here's what you need to know:
Who is affected? Generally, working-age adults (typically 19–64) without disabilities or caregiving responsibilities. Students, people with disabilities, pregnant women, and caregivers are usually exempt.
What counts as work? Employment, self-employment, volunteering, job training, school, caregiving. Most states give you credit for 80+ hours per month (roughly 20 hours/week).
If you don't meet the requirement: Your coverage may be suspended. But you can regain it by reporting work activity or applying for an exemption.
You must report changes within 30 days:
How to report: Online (easiest), by phone, by mail, or in person. Your state's Medicaid office has specific instructions.
During the COVID-19 pandemic, all states were required to maintain continuous Medicaid coverage (no automatic disenrollments). As of 2026, some states still have broader disenrollment protections. Check your state's policy.
Key point: Your coverage ends only if you become ineligible (income too high, assets too high, moved out of state) or you request termination. Failure to renew is not automatic disenrollment—always follow up.
A Medicaid denial isn't the end. You have rights, and you can appeal. Here's how.
Your state must provide a written explanation of why you were denied. Read it carefully. Common reasons include:
First step: Ask for clarification. Call your state Medicaid office and ask exactly why you were denied. Sometimes it's a data entry error or misunderstanding.
You have the right to appeal any denial or termination. Appeals are free and don't require a lawyer.
Timeline: You usually have 30–60 days from the notice to file an appeal. File as soon as possible.
How to appeal:
Say this: "I am requesting an appeal of the denial of Medicaid benefits dated [date]. I believe I am eligible for the following reasons: [list your reasons]." Attach copies of supporting documents.
If your appeal is denied, you can request a "fair hearing" before an administrative law judge (ALJ). This is a more formal process.
What happens: You get a notice of hearing. You appear (by phone or in person). The judge reviews your case and your evidence. You can bring documents, witnesses, or an advocate to help you.
Important: You don't need a lawyer, but you can bring one. Some legal aid organizations help with Medicaid hearings for free.
Decision: The ALJ issues a written decision. If you win, coverage is restored. You may be entitled to back coverage for the period you were wrongly denied.
If you're terminated from Medicaid but still have high medical needs, you might qualify for a "medically necessary services plan" or spend-down arrangement as a fallback. This is a temporary coverage for essential services only.
Ask your state if this is available if you lose coverage.
Medicaid is government health insurance for people with low income. One of its most valuable features is Home and Community-Based Services (HCBS)—the ability to receive long-term care in your home instead of a nursing facility. Here's how it works.
HCBS allows seniors and disabled people to receive assistance with daily living—bathing, dressing, meals, medication management—in their homes instead of institutions. Medicaid pays for:
Why this matters: Living at home is typically less expensive than nursing home care, and most people prefer it. Medicaid can save tens of thousands per year by supporting home care.
HCBS services are provided through state "waivers" of federal Medicaid rules. Here's what that means:
Waiver types: Each state has different waivers serving different groups—seniors (65+), physically disabled, developmentally disabled, brain injured. Check which waivers exist in your state.
Income & asset limits: Typically 300% of SSI (roughly $2,901/month for individuals in 2026) for "Medicaid only" pathways. Some waivers use higher limits.
Waiting lists: Many states have waiting lists for HCBS waivers because demand exceeds funding. Some lists can be years long. Apply early.
PACE is a different model: an integrated healthcare system that serves older adults (usually 55+) who are eligible for nursing home care but want to stay home.
What's included: Medical care, social services, day center services, transportation, meals, recreational activities—all coordinated by one team.
Cost: Usually free or low copay for Medicaid participants. PACE teams manage everything, including hospital care.
Availability: PACE is not available everywhere. Check www.npaonline.org to see if there's a PACE in your area.
Some states let you direct your own care. Instead of the state assigning a case manager and attendants, you hire and manage your own caregivers (with budget limits and oversight).
Advantages: More control, often more flexibility, ability to hire family members (with restrictions).
Disadvantages: More responsibility for hiring, payroll, background checks, and managing your care team.
Ask your state if consumer-directed supports are available.
If you need nursing home care or long-term Medicaid services, Medicaid looks at your assets. This section explains asset protection strategies, spousal rules, and what happens after you die.
Medicaid has a "look-back" period to prevent people from quickly giving away assets to qualify. For nursing home care and long-term services, Medicaid looks at the past 5 years of financial activity.
What this means: If you transferred assets (gave them away, sold them below market value, or structured transactions to hide them) in the past 5 years, Medicaid may penalize you by delaying coverage.
The penalty period: If Medicaid finds an improper transfer, it calculates a "penalty period"—usually several months of ineligibility based on the value of the transfer and your state's average nursing home cost.
There are legal ways to protect assets before needing Medicaid:
Plan early. Asset protection strategies are most effective when planned years in advance, not after a crisis.
If one spouse enters a nursing home and the other stays home, Medicaid has "spousal impoverishment" protections to keep the at-home spouse from losing everything.
In 2026:
This is complex. If you're married and face long-term care, consult an elder law attorney to understand your options.
After you die, Medicaid may try to recover the costs of care from your estate. Here's what you need to know:
What Medicaid can recover: Nursing facility care, hospital care, prescription drugs, and home and community-based services for people 55 and older.
From what: Your probate estate (assets that go through probate). NOT from: Life insurance, retirement accounts with beneficiaries, jointly owned property, trusts.
Protect your home: If you own a home and your spouse or minor/disabled child lives there, Medicaid cannot force a sale to recover costs during their lifetime. But after they pass, the state may place a lien.
Example: You receive $100,000 in nursing home care from Medicaid. After you die, the state tries to recover $100,000 from your estate. If your only asset is your home and your spouse still lives there, they're protected—but eventually the house may need to be sold to settle the Medicaid debt.
If you qualify for both Medicare and Medicaid, you're "dual eligible"—and you're in the best position possible for healthcare coverage. Here's how it works.
"Dual eligible" means you qualify for both Medicare (because you're 65+) and Medicaid (because your income is low). Many low-income seniors are dual eligible.
The benefits: Medicare covers hospital and doctor care; Medicaid fills in the gaps and covers services Medicare doesn't (like long-term care and dental). Together, they provide comprehensive coverage.
Example: Your Medicare Part B premium ($203/month) is paid by Medicaid. Your Medicare deductibles and copays are covered by Medicaid. You get vision and dental from Medicaid. Result: nearly comprehensive coverage with minimal out-of-pocket costs.
If you're dual eligible:
Some states offer special programs for dual-eligible people:
QMB (Qualified Medicare Beneficiary): Medicaid pays your Medicare Part B premium, deductible, and copays. Roughly $1,799/month income limit (2026).
SLMB (Specified Low-Income Medicare Beneficiary): Medicaid pays your Medicare Part B premium only. Roughly $2,154/month income limit.
QI (Qualifying Individual): Medicaid pays part of your Medicare Part B premium. Highest income limit of the three (~$2,432/month).
DSNP (Dual Eligible Special Needs Plan): A Medicare Advantage plan designed for dual-eligible people. Often has $0 premiums, includes prescription coverage, and some include dental/vision.
If you're dual eligible and taking multiple medications, you may qualify for "Extra Help" (Low-Income Subsidy) that pays for Medicare Part D prescription costs.
This covers: Premiums, deductibles, and copays for Part D drugs.
Income limit (2026): ~$1,799/month (135% of poverty level).
Apply at: Social Security, Medicare.gov, or your state Medicaid office. Many dual-eligible people qualify without realizing it.
Who pays first? Medicare is the primary payer. Medicaid is secondary. That means Medicare pays for covered services first; Medicaid picks up what Medicare doesn't cover.
Your deductibles and copays: Medicaid typically covers these (depends on your state and Medicaid group).
Services Medicare doesn't cover: Medicaid covers them (like nursing home care for 65+, dental, vision, hearing).
Important: Always show both your Medicare and Medicaid cards. Doctors need to see both.