Learn About Medicaid Application Steps and Options

Understanding Medicaid: What It Is and How It Works

Medicaid is a joint federal and state health insurance program that helps pay for medical care for people with lower incomes and limited resources. Unlike Medicare, which is a federal program based on age or disability, Medicaid is jointly funded by the federal government and individual states. This means each state runs its own Medicaid program with its own rules, coverage options, and income limits. Understanding this structure is important because the program you may learn about in one state could work differently in another.

The program covers a range of health services, including doctor visits, hospital stays, prescription medications, mental health services, and long-term care in some cases. Each state decides which services to cover beyond the federal minimum requirements. For example, some states cover dental work for adults, while others do not. Some states cover vision care, and some cover physical therapy with different limitations.

Medicaid began in 1965 as part of the Social Security Act. Over the decades, it has expanded to cover more people and more services. Currently, Medicaid covers more than 70 million people across the United States. The program serves children, pregnant women, parents, seniors, and people with disabilities. In 2014, the Affordable Care Act allowed states to expand Medicaid to cover more working-age adults, though not all states have chosen to do so.

The federal government sets broad guidelines for Medicaid, but states have considerable freedom in how they run their programs. This is why income limits, covered services, and other program details vary significantly from state to state. A person might be covered under Medicaid in one state but not in another state with different rules. Learning about your specific state's program is therefore a crucial first step in understanding what options might be available to you.

Takeaway: Medicaid is a state-based program jointly funded by federal and state governments. The services covered and income limits vary by state, so information about your specific state's program is more useful than general national information.

Income Limits and Financial Requirements for Different Groups

Medicaid income limits determine who can potentially use the program based on how much money a household makes. These limits are set as a percentage of the federal poverty level, which changes every year. The federal poverty level in 2024 is approximately $15,060 per year for an individual and $31,200 for a family of four. States set their own Medicaid income limits as a percentage of this federal poverty level, and these percentages vary widely.

For example, some states use 100% of the federal poverty level as their income limit, while others use 138% or even higher percentages. A few states use lower percentages. This means a family of four might be covered in one state at an income level where they would not be covered in another state. Additionally, different groups of people—such as children, pregnant women, parents, elderly individuals, and people with disabilities—often have different income limits within the same state.

Most states have expanded Medicaid under the Affordable Care Act to cover adults making up to 138% of the federal poverty level. However, some states have not expanded their programs and maintain much lower income limits for working-age adults. The difference can be substantial. In non-expansion states, a single adult might need to earn below $800 per month to potentially use Medicaid, while in expansion states, the limit could be around $1,500 per month or higher.

Beyond income, Medicaid also considers other financial factors, sometimes called "resources." This typically includes savings, investments, vehicles, and property beyond a primary residence. Resource limits vary by state and by the type of Medicaid program. Some programs have no resource limits, while others allow individuals to have several thousand dollars in savings and still potentially use the program. Different rules often apply for elderly individuals and people with disabilities compared to working-age adults and children.

Understanding your state's specific income and resource limits is essential because these numbers determine the first step in understanding whether the program might serve your situation. State Medicaid websites publish these limits, and they are updated annually. Community health centers and social service organizations can also provide information about current limits in your area.

Takeaway: Medicaid income limits vary significantly by state and by category of person (children, adults, elderly, disabled). Your household income determines whether you might learn more about what services could be available, so checking your state's current limits is an important starting point.

Categories of People Who May Access Medicaid

Medicaid serves many different groups of people, though the specific rules for each group vary by state. Understanding which category you might fall into helps you learn what options could be available. The main categories include children, pregnant and parenting women, elderly individuals, people with disabilities, and working-age adults without dependent children (in states that have expanded the program).

Children have been a core part of Medicaid since the program began. Most states cover children up to age 19 with household incomes at or below a certain percentage of the federal poverty level. Many states cover children with household incomes much higher than the limits for adults, sometimes up to 200% or more of the federal poverty level. This means a child in a household might potentially use Medicaid even when the child's parent or caretaker would not.

Pregnant women and new mothers are another important group. Most states cover pregnant women with incomes at or above the Medicaid level for other adults. After birth, many states continue coverage for mothers for a limited time, often 60 days or slightly longer. The exact timeframe varies by state. Children born to mothers covered by Medicaid are usually automatically covered at birth for a period of time. Prenatal care, delivery, and postpartum services are core covered services for this group.

Elderly individuals (typically age 65 and older) can use Medicaid if they meet income and resource limits. Many seniors use both Medicare and Medicaid together—sometimes called "dual eligible." Medicaid helps pay for services Medicare does not cover, such as long-term nursing home care and some in-home services. Resource limits for elderly individuals are often higher than for younger adults, reflecting the reality that older people may have accumulated savings.

People with disabilities, regardless of age, can potentially use Medicaid if they meet income and resource limits. Disability can be determined through the Social Security Administration's process or through separate state disability determinations. Services for people with disabilities often include physical therapy, mental health services, medications, and in some states, personal care assistance and home modifications.

Working-age adults without dependent children can use Medicaid in the 39 states (as of 2024) that have expanded the program under the Affordable Care Act. In these states, adults with household incomes up to 138% of the federal poverty level may potentially use the program. In the 12 states that have not expanded, working-age adults without children face very limited options.

Takeaway: Different groups have different rules within Medicaid. Identifying which category you fall into helps you understand what information about your state's program applies to your situation.

The Steps Involved in Learning About Coverage Options

Learning about Medicaid coverage options involves several steps, though the exact process varies depending on your state. The first step is to visit your state's Medicaid website or contact your state's Medicaid office. Each state has an official Medicaid agency, often housed within the Department of Health and Human Services or a similar department. State Medicaid websites contain information about income limits for different groups, covered services, and how to contact the program.

The second step is to gather information about your household's income and resources. You will need to know the gross monthly income of all household members and the total value of savings, investments, and other countable resources. Understanding what counts as income (wages, benefits, child support, rental income) and what counts as resources (bank accounts, stocks, retirement accounts) helps you determine what information you will need. State websites usually explain what counts and what does not.

The third step involves contacting your state's Medicaid program to ask questions about your situation. Many states now have online portals where you can explore coverage options without speaking to anyone directly. These tools often ask basic questions about household size and income to show you general information about whether coverage might apply to your situation. Some states still require phone contact or in-person visits to a local office.

The fourth step involves learning about the different types of Medicaid programs your state offers. Most states offer more than one program, each with slightly different rules. For example, a state might have one program for