Medicaid is both federal and state, but your state runs the program
Medicaid is a joint program: the federal government sets the basic rules and pays a share of the cost, but your state designs the program, decides who gets coverage, and handles the day-to-day work of enrolling people and paying doctors. This means the Medicaid program in your state may look different from the one next door — coverage limits, income thresholds, and which doctors participate all vary by state.
The federal government requires every state to cover certain groups (like children under 19 and pregnant people who meet income limits), but states can choose to cover more people or offer broader benefits. Some states have expanded Medicaid to cover more working-age adults; others have not. This is why your neighbor in a different state might have Medicaid coverage you do not, even with the same income.
Key Takeaways
- The federal government funds part of Medicaid and sets minimum coverage rules, but your state administers the program and decides most of the details.
- Income limits, covered services, and which doctors participate differ from state to state because each state designs its own Medicaid program.
- The federal government pays between 50 and 77 percent of Medicaid costs depending on your state's wealth; your state pays the rest.
- You contact your state Medicaid office or your state's health insurance marketplace to learn what coverage is available where you live.
How the federal government's role works
The federal government created Medicaid in 1965 and continues to set the floor for what states must cover. Federal law requires states to cover children, pregnant people, parents of dependent children, elderly people, and people with disabilities who fall below certain income thresholds. The federal government also sets rules about how states must process requests and how quickly they must make decisions.
In return, the federal government reimburses states for a portion of what they spend on Medicaid. The federal share ranges from 50 percent in wealthier states to 77 percent in poorer states. This means your state is always spending its own money on Medicaid, which is why states sometimes make changes to the program when their budgets tighten.
What your state decides about Medicaid
Your state chooses whether to expand Medicaid beyond the federal minimum, which groups of people to prioritize, what doctors and hospitals to contract with, and how much to pay those providers. Some states have expanded Medicaid to cover working-age adults with no children; others cover only the groups the federal government requires. Some states offer dental or vision coverage; others do not.
Your state also runs the enrollment process. You contact your state Medicaid office, your state's health insurance marketplace, or sometimes a local community health center to request coverage. Your state verifies your income, citizenship, and other facts, then tells you whether you meet the rules for coverage in your state. This is why the same income might make you covered in one state and not in another.
Why coverage differs between states
Because states design their own programs within federal guidelines, Medicaid coverage is not uniform across the country. A single parent earning $20,000 a year might have Medicaid in one state and no coverage option in another. A service covered in your state — like dental work or mental health visits — might not be covered in a neighboring state.
States also differ in how they handle the paperwork. Some states process requests quickly; others take longer. Some states use online portals; others require in-person visits or phone calls. These differences exist because states have different resources, different populations, and different political choices about how to run the program.
How to find out what Medicaid covers in your state
Start by contacting your state Medicaid office directly. You can find the phone number and website by searching "[your state] Medicaid" or by visiting your state's health department website. Your state office can tell you the income limits for your household size, which groups of people are covered, and what the next step is.
You can also use your state's health insurance marketplace, which is often the same place you would look for other insurance. Many states use Healthcare.gov; others run their own marketplaces. The marketplace will ask about your household income and size, then show you what coverage options are available to you in your state. If you are unsure which marketplace your state uses, search "[your state] health insurance marketplace."
What happens if you move to a different state
If you have Medicaid and move to a new state, your coverage ends on the last day of the month you move. You will need to contact your new state's Medicaid office to request coverage under that state's rules. Your new state will look at your income and household size under its own thresholds, which may be different from your old state.
Some people lose coverage when they move because their new state has lower income limits. Others gain coverage because their new state has expanded Medicaid. Plan to contact your new state's Medicaid office within the first week you arrive so there is no gap in coverage.
The difference between federal requirements and state choices
| What the Federal Government Requires | What Your State Decides |
|---|---|
| Coverage for children under 19 below a certain income | Whether to cover working-age adults with no children |
| Coverage for pregnant people below a certain income | How long after pregnancy coverage continues |
| Coverage for elderly and disabled people below a certain income | Whether to cover dental, vision, or hearing services |
| Basic hospital and doctor visits | Which hospitals and doctors participate in the program |
| A process for people to request coverage | How long the state has to make a decision |
Frequently Asked Questions
Can the federal government take away my Medicaid?
The federal government sets the rules states must follow, but your state administers your coverage. If your state decides to change its program, your coverage could change. However, the federal government requires states to follow a process before removing someone from Medicaid, so you would receive notice and a chance to respond before coverage ends.
Why do some states have better Medicaid than others?
States with more tax revenue can afford to cover more people and offer more services. States also make different political choices about how much to spend on Medicaid. Some states have chosen to expand Medicaid to cover more working-age adults; others have chosen not to, even though the federal government pays most of the cost.
If I move, will I keep the same Medicaid coverage?
No. Medicaid is a state program, so your coverage ends when you move. Your new state has its own income limits and covered groups, so you may or may not be covered under the new state's rules. Contact your new state's Medicaid office as soon as you move to find out what coverage is available.
Does the federal government pay for all of Medicaid?
No. The federal government pays between 50 and 77 percent of Medicaid costs depending on your state's wealth. Your state pays the rest from its own budget. This is why states sometimes make changes to Medicaid when their budgets are tight.