What Medicaid Covers and Who Runs It

Medicaid is a joint federal and state health insurance program for people with low income. Each state runs its own Medicaid program within federal guidelines, which means the income limits, covered services, and enrollment process differ by state. You cannot get Medicaid from a federal office — you work with your state's Medicaid agency, usually called the Department of Social Services, Department of Health and Human Services, or something similar.

Medicaid covers doctor visits, hospital care, prescription drugs, mental health services, and long-term care, though each state decides which services to include beyond the federal minimum. Some states cover dental and vision; others do not. Some cover physical therapy; others require a referral first. The program pays providers directly, so you typically pay nothing or a small copay at the point of care.

You do not pay a monthly premium for Medicaid the way you do for private insurance. However, some states charge small copayments for certain services, and a few states charge small monthly fees for enrollment — these vary widely and depend on your income and family size.

Key Takeaways

  • Medicaid income limits vary by state and family size, and they change yearly, so you must check your specific state's current limits rather than relying on a national figure.
  • You explore through your state's Medicaid agency, not through a federal office, and the process process and required documents differ by state.
  • Most states now use continuous enrollment, meaning once you are enrolled, you stay covered until you report a change in income or household — you do not have to reapply every year.
  • Some people are covered through Medicaid expansion programs, which your state may or may not have adopted, so your path to coverage depends partly on where you live.
  • If your income is just above the Medicaid limit, you may still be covered through a related program like the Marketplace with subsidies, so it is worth checking both.

Income Limits and How They Work

Medicaid uses your household income — not just your own earnings — to decide whether you meet the income limit. Household income includes wages, self-employment income, Social Security, unemployment benefits, child support, and other regular money coming in. It does not include food stamps, housing information, or certain other benefits.

The income limit depends on your family size and your state. A single person in one state might have a limit of $1,500 per month, while the same person in another state might have a limit of $2,000 per month. Some states use a percentage of the federal poverty line; others use their own calculation. Because these limits change yearly and vary so much, you cannot know whether you meet the limit without checking your state's current numbers.

To find your state's current income limits, go to your state Medicaid website — search "[Your State] Medicaid income limits" — or call your state's Medicaid hotline. The state website will also tell you whether your state has expanded Medicaid, which affects whether you are covered at all if you are an adult without children or a disability.

Who Qualifies: Categories and Special Situations

Medicaid covers different groups of people, and the rules differ by state. Children in low-income households are covered in all states. Pregnant people and new parents are covered in all states, though the income limit for parents is often lower than for children. People over 65 and people with disabilities are covered in all states if they meet the income and asset limits.

Working-age adults without children or a disability are covered only in states that have adopted Medicaid expansion. Expansion states cover adults up to a certain income level (usually around 138% of the federal poverty line); non-expansion states do not cover this group through Medicaid at all. If you live in a non-expansion state and do not fit another category, you may still be covered through the Marketplace with subsidies, which is a different program.

Some people are covered through special programs within Medicaid, such as programs for people with HIV, people receiving dialysis, or people in nursing homes. Your state's Medicaid website lists these programs and their specific rules.

How to Find Your State Medicaid Agency and explore

Start by finding your state's official Medicaid website. Search "[Your State] Medicaid" or go to Medicaid.gov and select your state from the map. The state website will have an process link, a phone number, and information about what documents you need to bring.

You can usually explore online, by mail, by phone, or in person at a local office. Online is fastest — you fill out a form, upload documents like pay stubs or a lease, and get a decision within days or weeks. By mail takes longer. By phone, a caseworker walks you through the questions and may ask you to mail documents later. In person, you bring documents with you and explore on the spot.

Have ready: proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of identity (driver's license or passport), proof of citizenship or immigration status, and proof of residence (a utility bill or lease). If you are explore for a child, bring their birth certificate. If you are pregnant, bring a letter from your doctor. The exact documents vary by state, so check your state's website first.

What Happens After You explore

After you submit your process, your state's Medicaid agency reviews it to confirm your income, household size, and whether you fit a covered category. This review usually takes 7 to 30 days, though it can take longer if the agency needs more information from you. The state will contact you by mail, phone, or email if they need documents you did not include.

If you are approved, you will receive a Medicaid card or a notice telling you how to access your coverage online. Coverage usually starts the first day of the month in which you applied, though some states backdate coverage to the first day of the month you became income-may be able to access. If you are denied, the notice will explain why and tell you how to request a hearing to appeal the decision.

Once you are enrolled, most states now use continuous enrollment, meaning you stay covered until your circumstances change — you do not have to reapply every year. However, you must report changes in income, household size, or address to your Medicaid agency. If your income rises above the limit, your coverage will end, usually at the end of the month in which you reported the change.

Medicaid Expansion and Non-Expansion States

In 2014, the Affordable Care Act gave states the option to expand Medicaid to cover more low-income adults. As of now, most states have adopted expansion, but some have not. This matters because in non-expansion states, a working-age adult without children or a disability cannot get Medicaid no matter how low their income is.

If you live in a non-expansion state and do not fit another Medicaid category, you may still be covered through the Marketplace — the federal or state health insurance exchange where you can buy private insurance with government subsidies. Marketplace coverage is different from Medicaid: you pay a monthly premium (though it may be very low or zero with subsidies), and you usually have a deductible and copays. To find out whether you may have access to for Marketplace subsidies, go to Healthcare.gov and enter your income and state.

To find out whether your state has expanded Medicaid, search "[Your State] Medicaid expansion" or call your state's Medicaid hotline. The state Medicaid website will also clearly state whether expansion is in place.

Assets, Resources, and Other Rules

Some Medicaid programs have asset limits — a cap on how much money or property you can own and still be covered. For children and pregnant people, most states do not have asset limits. For adults over 65 and people with disabilities, asset limits vary by state but are often around $2,000 for an individual and $3,000 for a couple. Assets include savings accounts, stocks, and property you own, but not your primary home or car.

If you are close to an asset limit, ask your state's Medicaid agency whether your specific situation counts against the limit. Some assets — like money in a special needs trust or certain retirement accounts — may not count. The rules are detailed and state-specific, so it is worth asking before you assume you are over the limit.

Medicaid also has rules about transfers of assets. If you give away money or property to become may be able to access for Medicaid, especially for long-term care coverage, the program may penalize you by delaying your coverage. These rules are complex and vary by state, so if you are considering giving away assets, talk to your state's Medicaid agency or a legal aid attorney first.

Frequently Asked Questions

Can I have Medicaid and private insurance at the same time?

Yes. If you have both, Medicaid usually pays second — it covers costs that your private insurance does not. This is called coordination of benefits. Tell both your Medicaid agency and your private insurer that you have both coverages so they can coordinate correctly.

What if my income goes up after I am enrolled?

You must report the income change to your Medicaid agency. If your new income is above your state's limit, your coverage will end, usually at the end of the month you reported the change. Your state will send you a notice with an end date. If your income is only slightly above the limit, you may be covered through the Marketplace instead.

How do I know if my state has expanded Medicaid?

Go to your state's Medicaid website and search for "expansion" or "adult coverage." You can also call your state's Medicaid hotline and ask directly. If your state has not expanded, a caseworker can tell you whether you might be covered through the Marketplace.

Can I explore for Medicaid if I am not a U.S. citizen?

It depends on your immigration status. U.S. citizens and most legal permanent residents can get Medicaid. Some legal immigrants have a waiting period before they are covered. Undocumented immigrants are not covered by regular Medicaid in most states, though some states cover emergency services or pregnancy care. Ask your state's Medicaid agency about your specific status.

What is the difference between Medicaid and Medicare?

Medicaid is for people with low income, regardless of age. Medicare is for people over 65 and some younger people with disabilities, regardless of income. They are separate programs run by different agencies. Some people have both — this is called "dual may be able to access." If you think you might may have access to for both, your state's Medicaid agency can help you sort it out.