10 Questions About Medicaid Answered

Medically Reviewed by Sarah Goodell on November 08, 2022
Written by Brenda Conaway
5 min read

Medicaid is a state and federal government health care program for people with low incomes. It provides low-cost or free health care to:

  • Low-income adults
  • Low-income families and children
  • People with disabilities
  • Certain older adults who use Medicare

The federal government sets basic guidelines for the types of care you can get with Medicaid and how much, if anything, you pay for it. But Medicaid benefits differ from one state to another. States can offer extra services. In some cases, people must pay something toward the cost of their care, while the same services may be free in another state. There can be other differences, too.

Some states have other special programs to help low-income people who don't qualify for Medicaid.

States have different rules to decide who's eligible for Medicaid. You may be eligible if:

You're disabled. Your state may let you use Medicaid no matter how much money you make in a year. In other states, a disabled person may only qualify for Medicaid when their income falls below a cutoff level.

You already get Supplemental Security Income (SSI). In the majority of states, SSI eligibility automatically qualifies you for Medicaid unless your state uses more strict criteria. Those states are commonly called 209(b) states.

You don't make much money during a year. The rules are different in each state.

Check with your state's Medicaid office to get the exact income requirements. You can also find out if you qualify by going online at www.healthcare.gov.

Some states have expanded their Medicaid program to allow more people to qualify. In those states, the income rules have loosened for adults without children. Other states have chosen not to expand Medicaid.

If your state has expanded Medicaid under the Affordable Care Act:

You're eligible if:

  • You're single, don't have children, and make less than $18,754 a year.
  • You have a family of three and make less than $31, 781 a year.

If your state has NOT expanded Medicaid:

  • Check with your state's Medicaid office for the rules and income limits. Eligibility is based on the modified adjusted gross income of your household, but eligibility levels vary according to your state and other factors, including whether you are pregnant, whether you have a family, and more. In states that have not expanded Medicaid, eligibility levels are lower than in states that have expanded.

In Alaska and Hawaii, you’re able to make a slightly higher income than in other states and still qualify. Your state Medicaid office can help you with the specific income limits based on how many people are in your family.

As of August 2020, 38 states and the District of Columbia have expanded Medicaid. 

In each state, Medicaid must cover:

  • Birth control medicine and devices
  • Care at rural and federally qualified health clinics
  • Care at many childbirth centers
  • Care from a pediatrician or family nurse practitioner
  • Early Periodic Screening, Diagnostic, and Treatment Services (EPSDT), which includes an array of services for children and adolescents
  • Doctor's fees
  • Home health services
  • Inpatient and outpatient hospital services
  • Lab tests and X-rays
  • Nurse midwife care during pregnancy and childbirth
  • Preventive care and immunizations for children under age 21
  • Quit-smoking programs
  • Transportation to medical care

Many states offer more care, such as checkups and cancer screening tests for adults, physical therapy, and occupational therapy.

For most health care services, you won't pay anything, or you'll have just a small copayment at the time of your visit. Most often, you show your Medicaid coverage card, and the state pays the full cost of your care to your doctor directly.

Some states, under a federal waiver, charge a monthly premium for certain eligibility categories.

You can usually look up doctors on your state's Medicaid web site. Or call the number on the site to talk with someone about finding a provider. Usually, Medicaid is administered by a private insurance company. In this case, call your insurer or look on its web site to find a participating provider.

Yes, if your income is not too high. Medicaid and The Children's Health Insurance Program (CHIP) provide low-cost coverage to millions of families with children. Income requirements vary by state. In all but two states, children who live in four-person households with incomes up to $56,890 qualify for either Medicaid or CHIP. Eighteen states and DC will cover children in families of four who earn even up to $84,630, although sometimes families at the higher eligibility levels may need to pay more for the coverage.

If you have a baby while you're on Medicaid, your baby will automatically be enrolled in Medicaid for their first year.

Yes, if you have been diagnosed with breast or cervical cancer through a state screening program and you have a low income. You can get medical treatment through your state's Breast and Cervical Cancer Prevention and Treatment Program.

Most states will cover pregnant women and may allow you to get Medicaid, even if you have a higher income than what is required to be eligible for the program.

You may in some situations. Medicare is a health insurance program for:

  • People ages 65 and older
  • People younger than age 65 who are disabled
  • People with end-stage kidney disease

With Medicare, you have to pay monthly premiums and other costs, such as copays and deductibles, when you go for medical care. If you are on Medicare and have a limited income, you may qualify for help from Medicaid to pay the costs of Medicare. If you have both Medicaid and Medicare, you may hear people refer to you as being dually eligible.

  • Start by going to Healthcare.gov. This web site is also called a Marketplace. You can find out if you qualify for Medicaid or other federal assistance to purchase health insurance. If your state has its own Marketplace, HeathCare.gov will send you to it.
  • Apply online.
  • You can also get in-person help signing up. To find a navigator near you, go to "Find Local Help" on Healthcare.gov.

 

You may need documents that show your income, home address, and other details.

Your benefits will last as long as you remain eligible.

If you get a new job or move to a different state, you need to report it -- usually within 10 days. Talk with a representative at the Medicaid office about how these changes will affect your coverage.