What is Medicaid?
Medicaid is health coverage for people with low income — plus specific groups like kids, pregnant women, seniors in long-term care, and disabled adults. About one in four Americans use it. It is not welfare. It is health insurance, run by your state, paid for by federal and state taxes you've already contributed to.
Dr. Ed Weir, PhD · 20 years inside Social Security · "Former" Sergeant, USMC
Updated April 2026
What is Medicaid?
Medicaid is a federal-state health coverage program for people with low income, kids, pregnant women, seniors in long-term care, and disabled adults. The federal government writes the rules and shares the cost; your state runs the program and decides applications. Around eighty million Americans — roughly one in four — use Medicaid or CHIP.
When you're not sure where to start with Medicaid, free help is closer than you think.
Free help finding what you may qualify for
Three doors that won't cost you anything: your state's Medicaid agency (every state runs its own intake), 2-1-1 (a free United Way helpline that knows local programs), and your local Area Agency on Aging if you're sixty or older. Skip any service that wants to charge you to apply for Medicaid — applications are always free, and a paid service can't get you anything you can't get yourself.
Here's what to do, in 4 steps.
Most people who think they make too much for Medicaid are wrong, and most people who think the application is impossible never tried Healthcare dot gov. Here's the order I'd run if I were starting today.
1. Find your state's Medicaid agency
Every state runs its own Medicaid program with its own name (sometimes 'Medicaid,' sometimes 'Department of Social Services,' sometimes something else). Use Medicaid.gov's state directory to find yours. That's where applications, renewals, and questions actually go.
Medicaid.gov state directory ›2. Check eligibility online before applying
Healthcare.gov has a free Medicaid screener for working-age adults under 65. For seniors or disabled adults, your state Medicaid agency's online screener handles the asset rules. Either way, fifteen minutes tells you yes, no, or maybe — and you may qualify even if you think you make too much.
Healthcare.gov Medicaid screener ›3. Gather what you'll need
Most state Medicaid applications ask for the same core documents: Social Security number, birth certificate, proof of citizenship or immigration status, proof of income (pay stubs or tax return), proof of household composition, and — for seniors and disabled adults — proof of resources (bank statements, property deeds). Missing documents are the single biggest cause of application delay.
4. Apply through your state, or get free help
Apply directly through your state's Medicaid agency portal, or through Healthcare.gov for working-age Medicaid (Healthcare.gov routes you to your state). For free help applying, call 2-1-1 (United Way) or your local Area Agency on Aging if you're sixty or older. Never pay an 'application service' — Medicaid applications are always free.
Healthcare.gov apply for coverage ›The numbers behind Medicaid
Which of these sounds more like you?
Medicaid means different things depending on who's asking. A working parent at the income line. A senior worried about a nursing home. A disabled adult who got SSI. Pick the one that sounds most like you.
I'm not sure if Medicaid is for me — I workYes — many working adults may qualify
Most people who think they make 'too much' for Medicaid are wrong. In the forty-plus states that adopted the Affordable Care Act expansion, working-age adults may qualify for Medicaid up to 138% of the federal poverty level — that's roughly $21,000 a year for a single adult, or about $43,000 for a family of four.
In non-expansion states, the income limits are lower for adults without kids, but kids and pregnant women still have generous eligibility almost everywhere. Run the Healthcare.gov screener — it takes fifteen minutes and tells you yes, no, or maybe.
What I saw at SSA was — people would assume they made too much, never apply, and find out years later they were leaving thousands of dollars in coverage on the table. Run the screener.
I confused Medicaid with MedicareThey're completely different programs
Medicare is for people 65 and older, or under 65 with certain disabilities, based on Social Security work history. Medicaid is for people with low income, at any age. The names rhyme; the programs don't overlap (much).
You can have both at the same time — it's called being 'dual-eligible,' and over twelve million Americans are. Medicare pays first; Medicaid picks up most of what Medicare leaves out, plus things Medicare doesn't cover (like long-term nursing-home care).
Don't get caught by this — these are two totally different programs run by two different agencies. Mixing them up means you might apply to the wrong one and waste weeks.
I'm worried Medicaid is 'welfare'It's not — and one in four Americans use it
Medicaid is health insurance. That's it. It's run by your state under federal rules, paid for jointly by federal and state taxes (the same taxes you've been paying for years), and used by around eighty million Americans — roughly one in four people in the country.
Medicaid recipients include kids in middle-income families, seniors in nursing homes, working adults at the income line, disabled adults on SSI, and pregnant women across a wide income range. It's mainstream coverage, not a fringe program.
I'm 65 or older and on a fixed incomeMedicaid for seniors works differently
Medicaid for seniors is a different doorway than Medicaid for working-age adults. The income rules are tighter. There are asset limits (typically around $2,000 for a single person, though states vary). And long-term care coverage — nursing home or in-home care — has its own rules including a five-year look-back on asset transfers.
If you're already on Medicare and your income is low, you may qualify for a Medicare Savings Program that pays your Part B premium and some cost-sharing. That's a separate, simpler doorway worth checking first.
I'm a flashlight, not a courtroom — the rules for senior Medicaid (asset limits, look-back, spousal impoverishment) are state-specific and worth running by an elder-law attorney or your local Area Agency on Aging before you make moves.
I'm disabled but not on SSI yetThere's a separate Medicaid disability pathway
If you're approved for SSI (Supplemental Security Income), you get Medicaid automatically in most states — that's the cleanest path. About thirty-four states use the federal SSI rules and trigger Medicaid the moment SSI is approved.
If you're disabled but not on SSI, your state likely has a separate Medicaid disability pathway with its own income and asset rules. Some states also have a 'Medicaid Buy-In for Working Disabled' program with higher income limits if you're working. Your state Medicaid agency or your local Area Agency on Aging can walk you through the options.
I just need to know where to startThree steps: state agency, screener, apply
Step one: find your state's Medicaid agency on Medicaid.gov's directory. Step two: run the Healthcare.gov screener (or your state agency's screener) for a fifteen-minute yes/no/maybe. Step three: apply through your state agency's portal or Healthcare.gov.
That's it. Don't pay anyone to apply for you. Don't wait until something's wrong. The application process is free, the help is free, and you may qualify even if you don't think you do.
What I saw at SSA was — people would spend months researching when thirty minutes on Healthcare dot gov would have told them yes or no. Just run the screener.
I'm helping a parent figure out if they qualifyDifferent rules apply for seniors
If you're helping a parent who's 65 or older and worried about long-term care, the Medicaid rules are different from working-age Medicaid. There are asset limits (typically around $2,000 for a single person, with state variation), a five-year look-back on asset transfers, and special rules to protect the spouse who isn't applying (called 'spousal impoverishment' protections).
Start with three free resources: their state Medicaid agency (Medicaid.gov has the directory), their local Area Agency on Aging (eldercare.acl.gov has the locator), and 2-1-1 (free helpline that knows local programs). For long-term care planning specifically, consider an elder-law attorney — NAELA at naela.org has a 'find an attorney' tool. Don't transfer assets without legal advice; the look-back rules are unforgiving.
My situation is different from theseTell me what's specific to you
Medicaid has more doorways than any one page can cover — pregnancy Medicaid, kids and CHIP, foster care alumni, breast and cervical cancer treatment programs, presumptive eligibility for hospital inpatients, and dozens of state-specific waivers.
If nothing above sounds quite like you, three places will sort it out at no cost: your state's Medicaid agency directly, 2-1-1 (the free United Way helpline that knows your state's program), or your local Area Agency on Aging if you're sixty or older. They'll tell you which doorway fits your situation.
Three free doors: your state Medicaid agency, 2-1-1, or your local Area Agency on Aging. None of them will charge you a dollar to figure out where you fit.
Other programs Medicaid recipients often qualify for
If you qualify for Medicaid, you may also qualify for one or more of these. Many states use a combined application — apply once, get screened for several.
Medicare
If you're 65 or older, or under 65 with certain disabilities tied to Social Security work history, you may qualify for Medicare alongside Medicaid. Dual-eligibles get more coverage than either program alone.
SSI (Supplemental Security Income)
If you're disabled or sixty-five-plus with very low income and limited resources, you may qualify for SSI — and in most states, SSI approval triggers Medicaid automatically.
SNAP (Food Benefits)
Most Medicaid recipients also may qualify for SNAP food benefits. Many states use a combined application — apply for Medicaid and SNAP together and let the state screen you for both.
LIHEAP (Energy Bill Help)
If your income qualifies you for Medicaid, it likely also qualifies you for LIHEAP — federal help with heating and cooling bills. Apply through your state's LIHEAP office or 2-1-1.
CHIP (Children's Health Insurance Program)
If your kids don't qualify for Medicaid because your income is just over the limit, they may qualify for CHIP — same agency, slightly higher income ceiling, low or zero premiums.
Marketplace (ACA) coverage with subsidies
If your income is just above the Medicaid limit, you may qualify for Marketplace insurance with premium tax credits at Healthcare.gov. The same application screens you for both.
Everything people ask me
What is Medicaid in plain English?
Medicaid is a health insurance program for people with low income, plus specific groups like kids, pregnant women, seniors in long-term care, and disabled adults. It's a federal-state partnership: the federal government writes the rules, and your state runs the program. About 80 million people use Medicaid and CHIP — roughly one in four Americans.
Who runs Medicaid?
Two layers. Federally, the Centers for Medicare & Medicaid Services (CMS), part of the U.S. Department of Health and Human Services, writes the rules. In your state, your state's Medicaid agency runs the program — it handles applications, approvals, renewals, and provider payments. Your state may call it 'Department of Social Services,' 'Department of Health Services,' or something similar; the function is the same.
How is Medicaid funded?
Joint federal-state funding. The federal government matches state Medicaid spending at a rate called FMAP (Federal Medical Assistance Percentage), ranging from 50% (the federal floor) to 83% depending on the state's per-capita income. For the ACA Medicaid expansion population (working-age adults up to 138% of the federal poverty level), the federal match is 90%.
Who's covered by Medicaid?
Roughly four pathways. (1) Working-age adults under 65 with low income (called 'MAGI Medicaid' — broader in the 40+ states that adopted ACA expansion). (2) Seniors, blind, and disabled adults (called 'ABD Medicaid' — with asset limits). (3) Kids in low- and moderate-income households (Medicaid plus CHIP). (4) People who need long-term care (institutional Medicaid plus home and community-based services waivers). Different rules for each pathway.
Is Medicaid free?
For most adults, yes — zero premiums, zero or near-zero copays. States can charge small premiums or copays for specific populations (CHIP families, working-disabled buy-in programs, some MAGI groups), but federal rules cap total out-of-pocket cost-sharing at 5% of family income. Most Medicaid recipients pay nothing.
What's the difference between Medicaid and Medicare?
Medicare is for people 65 and older, or under 65 with certain disabilities, based on Social Security work history. Medicaid is for people with low income — at any age. You can have both at the same time (it's called 'dual-eligible') — over twelve million Americans do, and they get coverage that either program alone wouldn't provide.
Can I have Medicaid AND Medicare?
Yes. About twelve million Americans are 'dual-eligible' — they qualify for both. Medicare pays first for medical care; Medicaid picks up most of what Medicare leaves out (deductibles, coinsurance, Part B premium for those at lower incomes) plus things Medicare doesn't cover, like long-term nursing-home care.
Where do I apply for Medicaid?
Through your state's Medicaid agency. Two ways in: directly through your state agency's online portal (Medicaid.gov has the directory), or through Healthcare.gov for working-age MAGI Medicaid — Healthcare.gov routes your application to your state. Paper applications are also available. There is no 'Medicaid.gov apply here' button; applications go to states, not the federal government.
What does Medicaid cover?
Federal rules require states to cover a long list of mandatory services: doctor visits, hospital inpatient and outpatient, lab and X-ray, family planning, pregnancy and birth, kids' dental and vision (called EPSDT for under-21), nursing facility care, and home health. States can add optional services like dental for adults, vision for adults, and prescription drugs — most states cover all three. Specific coverage varies by state.
What if my Medicaid application is denied?
You have the right to a 'fair hearing' — a state-level appeal under federal regulations (42 CFR Part 431, Subpart E). Deadlines vary by state but are typically 30 to 90 days from your denial notice. In some cases you can keep your existing benefits during the appeal. Free legal help is available through Legal Aid in most states. Don't wait — appeal deadlines are short.
Sources
Every figure and rule on this page is verified against primary sources. Last verified 2026-04-28.
- Medicaid was created by the Social Security Amendments of 1965 (Title XIX, Public Law 89-97), signed by President Lyndon Johnson on July 30, 1965. —ssa.gov(verified 2026-04-28)
- The Centers for Medicare & Medicaid Services (CMS), part of the U.S. Department of Health and Human Services, is the federal agency that administers and oversees Medicaid. —cms.gov(verified 2026-04-28)
- Federal Medicaid regulations are codified at 42 CFR Parts 430–456 (Subchapter C of Title 42, Chapter IV). —ecfr.gov(verified 2026-04-28)
- State Medicaid agencies handle eligibility determinations, applications, and renewals — not the federal government. Each state's contact information is available through Medicaid.gov's state … —ecfr.gov(verified 2026-04-28)
- Federal Medicaid rules cap total out-of-pocket cost-sharing at 5% of family income per quarter (42 CFR § 447.56). —ecfr.gov(verified 2026-04-28)
- Medicaid eligibility pathways include MAGI (Modified Adjusted Gross Income) for adults under 65 with low income, ABD (Aged, Blind, Disabled) non-MAGI for seniors and disabled adults, long-term care … —ecfr.gov(verified 2026-04-28)
- Medicaid recipients have the right to a fair hearing if their application is denied or benefits are terminated, per 42 CFR Part 431, Subpart E. —ecfr.gov(verified 2026-04-28)
- Medicaid is codified at 42 USC § 1396 et seq. (Title XIX of the Social Security Act). —uscode.house.gov(verified 2026-04-28)
- The Federal Medical Assistance Percentage (FMAP) — the federal share of state Medicaid spending — ranges from 50% (the federal floor) to 83% depending on the state's per-capita income. —law.cornell.edu(verified 2026-04-28)
- The Affordable Care Act Medicaid expansion population receives a 90% federal match — higher than the standard FMAP — under section 2001 of the ACA (P.L. 111-148). —law.cornell.edu(verified 2026-04-28)
- Medicaid and CHIP together cover more than 75 million Americans — with 75,263,587 people enrolled across the 50 states and DC as of January 2026 — making it the largest single source of health … —medicaid.gov(verified 2026-04-28)
- The ACA Medicaid expansion raised the income limit for working-age adults to 138% of the federal poverty level in expansion states. —law.cornell.edu(verified 2026-04-28)
- As of 2026, more than 40 states and the District of Columbia have adopted the ACA Medicaid expansion. —kff.org(verified 2026-04-28)
- Federal law (42 USC 1396a(a)(10)(A)) requires state Medicaid programs to cover specific mandatory services including inpatient and outpatient hospital, physician services, lab and X-ray, family … —uscode.house.gov(verified 2026-04-28)
- Medicaid is the primary payer of long-term services and supports in the United States, financing care for more than 6 in 10 (over 60%) of nursing facility residents nationally as of July 2024 (KFF … —kff.org(verified 2026-04-28)
Helping a parent figure out Medicaid?
If you're helping a parent or older relative work out whether they qualify, the rules are different from working-age Medicaid. Asset limits matter. State variation is huge. Start with their state Medicaid agency, their local Area Agency on Aging, or 2-1-1. Bring their Social Security number, proof of income, and a list of any savings or property.
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Medicaid rules shift every year. State expansions, income limits, asset rules, the federal match. I'll send you a short note when something changes that matters to you.
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