Medicaid covers people in specific situations, not everyone

Medicaid is a joint federal and state program that pays for medical care for people with low income. Each state runs its own Medicaid program, so the people it covers and the services it pays for vary by state. You cannot walk into a Medicaid office and get coverage just because you have low income — you have to fit into one of the categories your state recognizes.

The main categories are: children under 19, pregnant people, parents or caretakers of children, people over 65, people who are blind or disabled, and people in long-term care facilities. Some states have expanded Medicaid to cover more working-age adults with low income, but not all have. Your state's rules determine whether you fit into a category that gets coverage.

Key Takeaways

  • Medicaid covers children, pregnant people, parents of children, seniors over 65, and people who are blind or disabled, but the exact income limits and rules vary by state.
  • Some states have expanded Medicaid to cover more working-age adults, while others have not, so your state determines what categories exist.
  • You must be a U.S. citizen or may have access to immigrant and meet your state's income and asset limits to be covered.
  • The fastest way to learn what your state covers is to contact your state Medicaid office directly or use the 211 helpline to find your local office.
  • Medicaid covers doctor visits, hospital stays, prescriptions, and some dental and vision care, but coverage details differ by state.

Children and pregnant people

Medicaid covers children under 19 in all states. The income limit for children is usually higher than the limit for adults, so a child in your household might be covered even if you are not. Most states cover children whose family income is up to 200 percent of the federal poverty line, though some go higher.

Pregnant people are covered in all states, regardless of immigration status in some cases. Coverage usually continues for 60 days after the pregnancy ends, whether the pregnancy resulted in a birth or not. This is one of the broadest categories Medicaid covers, because federal law requires states to include it.

Parents and caretakers of children

Medicaid covers parents and caretakers who care for children under 19, but the income limits are much lower than for children themselves. In states that have not expanded Medicaid, a parent might earn only 40 to 50 percent of the federal poverty line and still be covered — meaning a family of three earning around $900 per month. In states that expanded Medicaid, the limit is usually higher.

A caretaker does not have to be a parent. If you are a grandparent, aunt, uncle, or other relative caring for a child, you may be covered under this category in your state. The child must live with you and you must be responsible for their care.

People over 65 and people who are disabled or blind

Medicaid covers people 65 and older with low income, even if they also have Medicare. Many seniors have both programs — Medicare pays first, and Medicaid covers costs Medicare does not pay. This is called "dual may be able to access" status.

Medicaid also covers people under 65 who are blind or disabled, as determined by the Social Security Administration. You do not have to be receiving Social Security Disability Insurance (SSDI) to be covered, but you do have to meet Social Security's definition of disability. The income and asset limits for this category are usually higher than for other groups, and some states allow you to keep more assets and still be covered.

Working-age adults in expansion states

Some states have expanded Medicaid to cover working-age adults with income up to 138 percent of the federal poverty line, regardless of whether they are parents, disabled, or in any other category. As of now, about 40 states have done this expansion, but not all. If you live in a state that expanded Medicaid, you may be covered even if you work and do not fit into any of the traditional categories.

If you live in a state that has not expanded Medicaid, you can only be covered if you fit into one of the categories above. There is no general "low-income adult" category in non-expansion states. This is one of the biggest differences between states — two people with identical income and family situation can be covered in one state and not in another.

Income and asset limits vary by state and category

Medicaid has income limits, but they are not the same everywhere. The federal poverty line is the starting point, but each state sets its own limits as a percentage of that line. A single person in one state might be covered at 100 percent of poverty, while in another state the limit is 200 percent. Your state's Medicaid office publishes these limits, and they change once a year.

Most Medicaid programs also have asset limits — the amount of money and property you can own and still be covered. For most categories, the limit is around $2,000 for a single person and $3,000 for a couple, though some states are higher and some categories have no asset limit at all. Your home and one car usually do not count toward the asset limit.

Citizenship and immigration status requirements

You must be a U.S. citizen or a may have access to immigrant to be covered by Medicaid in most cases. may have access to immigrants include people with a green card, people granted asylum, refugees, and some other statuses. Undocumented immigrants are not covered by regular Medicaid in most states, though some states pay for emergency care only.

A few states cover pregnant people and children regardless of immigration status, and some states have their own programs for undocumented immigrants. If you are not a citizen, contact your state Medicaid office or a local immigrant services organization to learn what your state covers.

What Medicaid pays for

Medicaid covers doctor visits, hospital stays, emergency care, prescription drugs, and lab tests in all states. Most states also cover dental care, vision care, and mental health services, though the details vary. Some states cover more services than others — for example, some cover physical therapy and some do not.

Your state Medicaid program publishes a list of covered services. If you are trying to figure out whether a specific service is covered, contact your state Medicaid office or ask your doctor's office to check for you. Coverage can change, so it is worth checking directly rather than relying on information from a year ago.

Frequently Asked Questions

How do I find out what my state's Medicaid covers?

Contact your state Medicaid office directly — the number is on your state's health department website. You can also call 211 and ask for your local Medicaid office. Both can tell you the income limits, asset limits, and covered services for your state and your situation.

Can I be covered if I work?

Yes. Medicaid covers working people in all states if they fit into one of the covered categories — for example, if you are a parent with low income, or if you live in an expansion state. Some states have work incentive programs that let you earn more and still be covered. Ask your state Medicaid office about work rules in your state.

What if I am over 65 and have Medicare?

You can have both. If you are 65 or older with low income, you may be covered by Medicaid even if you have Medicare. Medicaid will pay for costs Medicare does not cover, like copayments and deductibles. Contact your state Medicaid office to learn the income limits for seniors in your state.

Does Medicaid cover dental and vision care?

Most states cover some dental and vision care through Medicaid, but the coverage varies widely. Some states cover routine cleanings and exams, while others cover only emergency care. Ask your state Medicaid office what is covered for your category, or check your state's Medicaid website.

What happens if my income goes up?

If your income rises above your state's limit, you will lose Medicaid coverage. Some states have a grace period or allow you to keep coverage for a few months while you transition to other insurance. Report income changes to your state Medicaid office as soon as they happen — do not wait for them to find out.