At-a-Glance: Medicaid & the Affordable Care Act

Medically Reviewed by Sarah Goodell on September 16, 2022

Medicaid helps people with limited incomes get health care at a low cost or free. It's a partnership between the federal and state governments. The federal government sets the rules for the basic Medicaid program, including who qualifies and what basic benefits are offered. State governments can choose to cover more people and provide more benefits.

The Affordable Care Act adds more people and more benefits to the basic Medicaid program, but only in states that choose to expand Medicaid. As of September 2022, 38 states and the District of Columbia had expanded their Medicaid program.

If you already use Medicaid to help pay for doctor's visits, or if you think you can get it, here's what the Affordable Care Act means for you.

If You Get Medicaid Now, You May Still Qualify

People with low incomes who've been helped by Medicaid continue to qualify. This includes:

  • Children
  • People with disabilities
  • Pregnant women
  • Parents who are working at low paying jobs or are not working (in some states)
  • Some older adults

Adults Without Children Qualify in Some States

If you are an adult and don't make much money, you may be eligible for Medicaid. In the past, childless adults could not receive Medicaid, except in a few states.

If the state where you live is expanding Medicaid, you may be eligible if your annual income is no more than about $18,754 or one person and about $38,295 for a family of four. However, the income thresholds range from state to state, so you may be eligible for Medicaid if you earn more.

If the state where you live is NOT expanding Medicaid, you can't get Medicaid under the new Affordable Care Act rules. But if your income is very low, you should still check to see if you qualify. In addition, you may be able to get a type of financial aid, called a subsidy, to help pay for health insurance by shopping at your state's Marketplace web site. There are two types of subsidies.

  • A tax credit is money that helps to lower your monthly premiums.  
  • A cost-sharing subsidy is a type of financial aid that lowers your costs when you go for your health care services. It lowers your deductible, which is the amount you have to pay before insurance helps pay. It also lowers how much you pay when you see a doctor or buy prescription medicine.

Find out the rules in your state and whether you qualify at

Types of Benefits for People Newly Eligible for Medicaid

For people who are newly eligible for Medicaid because of the Affordable Care Act, Medicaid will help pay for:

  • Quit-smoking programs
  • The same basic benefits as someone who buys insurance through their state's Marketplace. These are called essential benefits and include:
    • Addiction treatment
    • Care for children (including vision and dental care)
    • Care for newborn babies
    • Maternity care
    • Hospital care
    • Doctor visits
    • Emergency care
    • Lab tests
    • Mental health care
    • Occupational therapy
    • Physical therapy
    • Certain prescription medicines
    • Preventive care, like cancer screenings and vaccines
    • Speech-language therapy
    • Treatment for long-term diseases, like diabetes and asthma

In addition, each state can decide whether to offer these new benefits:

  • Health Homes are new places that will coordinate the care for people using Medicaid who have more than one chronic condition. The conditions include asthma, diabetes, heart disease, mental health, and substance abuse.
  • More support to help you stay out of a nursing home. Nursing homes are also called long-term care institutions. Support may include more care in your home or financial help to keep you at home.

Show Sources

SOURCES: "How Will Medicaid Change?" "Eligibility;" "State Profiles;" "Medicaid Benefits;" "Health Homes;" and "Long Term Services and Support."

U.S. Department of Health and Human Services: "2013 Poverty Guidelines, One Version of the [U.S.] Federal Poverty Measure."

Kaiser Family Foundation: "Explaining Health Reform: The New Rules for Determining Income Under Medicaid in 2014;" "What Is a Health Insurance Exchange?" and "State Activity Around Expanding Medicaid Under the Affordable Care Act, as of April 2, 2013."

American Public Health Association: "Supreme Court Decision."

Stephens, Jessica. JAMA. March, 2013.

© 2022 WebMD, LLC. All rights reserved. View privacy policy and trust info