Medicaid: Eligibility, Coverage, How to Apply

What Is Medicaid?

Medicaid is the largest public health insurance program in the United States. It provides free or low-cost medical coverage to about 91 million Americans, including children, pregnant women, seniors, and adults with low incomes. The Centers for Medicare & Medicaid Services (CMS), part of the U.S. Department of Health and Human Services, runs the program at the federal level.

Unlike private insurance, Medicaid charges no monthly premiums in most states and has little to no cost at the point of care. The federal government and states share the cost of funding Medicaid. The federal government pays at least 50% of each state's Medicaid costs, and more in lower-income states. For expansion populations, the federal government covers 90% of the cost.

Many states use their own name for the program. California calls it Medi-Cal. New York runs it through NY State of Health. Texas uses the YourTexasBenefits portal. No matter what your state calls it, every state must cover a set of federally required services. Check your state benefits page for local details.

Congress created Medicaid in 1965 alongside Medicare as part of the Social Security Amendments. The Affordable Care Act (ACA) of 2010 expanded Medicaid to cover all adults with income up to 138% of the federal poverty level (FPL). As of 2026, 40 states and the District of Columbia have adopted the expansion. The remaining 10 states have not expanded, which leaves a coverage gap for some low-income adults.

Who Qualifies for Medicaid?

Eligibility depends on your income, household size, age, and whether your state expanded Medicaid. In expansion states, most adults ages 19 to 64 qualify if their household income falls at or below 138% of the federal poverty level. Children qualify at higher income levels in every state.

Income Limits in Expansion States (2026)

Source: HHS Federal Poverty Level Guidelines. 138% FPL for the 48 contiguous states and DC, effective 2026.

These limits apply to adult Medicaid in expansion states. In non-expansion states like Texas, adult coverage is limited mostly to parents with very low income, pregnant women, and people with disabilities. Childless adults in non-expansion states often fall into a "coverage gap" where they earn too much for Medicaid but too little for ACA marketplace subsidies.

Children and CHIP

Children generally qualify for Medicaid or the Children's Health Insurance Program (CHIP) at higher income levels than adults. In most states, children can qualify with household income up to 200% to 300% of FPL. In California, children qualify up to 266% FPL through Medi-Cal. In Texas, the limit is 201% FPL. CHIP covers children in families that earn too much for Medicaid but cannot afford private insurance.

According to CMS data, about 40 million children are enrolled in Medicaid and CHIP combined. This makes it the single largest source of health coverage for children in the country.

Pregnant Women

Pregnant women qualify for Medicaid at higher income limits in every state. The federal minimum is 138% FPL, but most states set the limit between 185% and 200% FPL or higher. In California, pregnant women qualify up to 213% FPL. Coverage starts as soon as you apply and continues through 12 months postpartum in most states, thanks to a provision in the American Rescue Plan Act.

Seniors and People with Disabilities

Adults age 65 and older may qualify for Medicaid if they have limited income and assets. Many seniors use Medicaid alongside Medicare to cover costs that Medicare does not pay, like long-term nursing home care. People with disabilities who receive Supplemental Security Income (SSI) automatically qualify for Medicaid in most states. Medicaid is the largest payer of long-term care services in the country, covering about 60% of all nursing home residents according to CMS.

Citizenship and Residency

You must be a U.S. citizen or qualified non-citizen and a resident of the state where you apply. Qualified non-citizens include lawful permanent residents, refugees, and asylees. Lawful permanent residents may face a five-year waiting period in some states before they can access full Medicaid, though many states have waived this for children and pregnant women. Emergency Medicaid is available to all residents regardless of immigration status for emergency medical conditions.

You can use our free screener to check your eligibility for Medicaid and other programs in about five minutes.

What Does Medicaid Cover?

Medicaid covers a wide range of medical services. Federal law requires states to cover certain "mandatory" services, and states can choose to cover additional "optional" services. The value of Medicaid coverage is worth roughly $8,000 to $12,000 per year per person.

Required Services (All States)

Every state Medicaid program must cover these services:

• Inpatient hospital care: Stays in the hospital for surgery, illness, or other treatment.
• Outpatient hospital and clinic services: Emergency room visits, same-day surgery, and hospital clinic visits.
• Doctor and physician services: Primary care visits, specialist appointments, and preventive care.
• Laboratory and X-ray services: Blood tests, imaging, and diagnostic testing.
• Prescription drugs: Most states cover a broad list of medications. Some charge small copays of $1 to $4 per prescription.
• Mental health services: Counseling, therapy, psychiatric care, and substance use treatment.
• Nursing facility services: Long-term care in a nursing home for eligible adults.
• Home health care: Nursing visits, medical equipment, and therapy delivered at home.
• Preventive care and screenings: Routine checkups, immunizations, and cancer screenings.
• Family planning services: Contraception, counseling, and related medical services.
• Transportation to medical appointments: Non-emergency medical transportation (NEMT) to get you to and from doctors and clinics.

Optional Services (Varies by State)

Many states also cover these services, though benefits vary:

• Dental care: About 35 states cover at least some dental services for adults. Children receive dental coverage through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit in all states.
• Vision care: Eye exams and glasses for adults are optional but covered in many states. Children receive vision coverage in all states.
• Hearing aids: Covered for children in all states and for adults in some states.
• Physical and occupational therapy: Rehabilitation services beyond what is federally required.
• Prescription drug coverage beyond the minimum: Some states cover a wider range of medications.

No Premiums in Most States

Most Medicaid enrollees pay no monthly premiums. Some states charge small monthly premiums for adults with incomes closer to the 138% FPL limit, usually between $10 and $25 per month. Copays for services are minimal and cannot exceed a few dollars per visit. States cannot charge premiums or copays for children, pregnant women, or the very poorest enrollees. According to Medicaid.gov, total out-of-pocket costs for a Medicaid enrollee cannot exceed 5% of household income.

How to Apply for Medicaid

You can apply for Medicaid online, by phone, by mail, or in person. The process is free and available year-round. Unlike private health insurance through the ACA marketplace, Medicaid has no open enrollment period.

Step 1: Check your eligibility

Use our free eligibility screener or review the income limits above. The screener takes about five minutes and checks Medicaid along with 20 other programs.

Step 2: Gather your documents

You will need:

• Proof of identity (driver's license, state ID, or passport)
• Proof of income (pay stubs, tax return, or employer letter)
• Social Security numbers for all household members applying
• Proof of citizenship or immigration status
• Proof of state residency (utility bill, lease, or bank statement)
• Proof of pregnancy (if applicable)

Step 3: Submit your application

Online: Visit HealthCare.gov to apply in most states. Some states have their own application portals. In California, use Covered California. In Texas, use YourTexasBenefits.com. In New York, use NY State of Health.

Phone: Call your state Medicaid office or dial 211 for a referral. You can also call the federal marketplace at 1-800-318-2596 for help.

In person: Visit your county Department of Social Services, community health center, or local Medicaid office. Hospitals and clinics can also help you apply.

Mail: Download a paper application from your state Medicaid agency website and mail it to your local office.

Step 4: Complete your interview (if required)

Some states require a phone or in-person interview. Others process your application based on the documents you submit. Your state will contact you if they need more information.

Step 5: Receive your decision

Most states process Medicaid applications within 45 days. For pregnant women and children, states must process applications within 30 days. If approved, you will receive a Medicaid card or information about choosing a health plan. Coverage can be backdated up to three months before your application date if you would have been eligible during that time.

Tips for a Smooth Application

Apply as soon as you think you might qualify. Medicaid coverage can start from the date of your application, and retroactive coverage can go back three months. Even if you are missing some documents, submit your application first and provide the rest later.

If you are denied, the denial letter will explain the reason and how to appeal. You have the right to request a fair hearing. Many denials result from missing documents or income reported incorrectly. Resubmitting with correct documents often resolves the issue.

If you are in a non-expansion state and do not qualify for Medicaid, check the ACA marketplace for subsidized private insurance. Many people with low incomes qualify for plans with $0 premiums through marketplace subsidies.

Medicaid and Other Programs

Many people who qualify for Medicaid also qualify for other federal and state benefits. Receiving Medicaid does not reduce your eligibility for most other programs. Here are some programs worth checking:

• SNAP (Supplemental Nutrition Assistance Program) provides monthly grocery benefits on an EBT card. Many Medicaid recipients also qualify for SNAP based on similar income limits.
• WIC (Women, Infants, and Children) offers food packages, nutrition education, and referrals for pregnant and postpartum women and children under five. The income limit is 185% FPL.
• LIHEAP (Low Income Home Energy Assistance Program) helps pay heating and cooling bills. If you qualify for Medicaid, you likely qualify for LIHEAP as well.
• TANF (Temporary Assistance for Needy Families) provides cash assistance to families with children. Receiving TANF often qualifies you automatically for Medicaid.
• SSI (Supplemental Security Income) provides monthly cash payments to people with disabilities and seniors with limited income. SSI recipients automatically qualify for Medicaid in most states.
• Free and reduced school meals: Children in Medicaid households often automatically qualify for free school breakfast and lunch programs.

Our free screener checks Medicaid and all of these programs at once.

Frequently Asked Questions

What is the difference between Medicaid and Medicare?

Medicaid is for people with low incomes, regardless of age. Medicare is for people age 65 and older and some younger people with disabilities. Medicaid is funded jointly by the federal government and states. Medicare is a fully federal program. Some people qualify for both programs at the same time. These "dual eligible" individuals get coverage from both programs, with Medicaid often covering costs that Medicare does not, like long-term care and dental services.

Can I get Medicaid if I am working?

Yes. Medicaid eligibility is based on your income, not your employment status. In expansion states, a single adult working full time at $15 per hour (about $31,200 per year) would be above the income limit. But a single adult earning about $10 per hour (roughly $20,800 per year) would likely qualify. Many part-time workers and people in lower-wage jobs qualify for Medicaid while employed.

Does my state have Medicaid expansion?

As of 2026, 40 states and the District of Columbia have expanded Medicaid. The 10 states that have not expanded are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Texas, Tennessee, Wisconsin, and Wyoming. If you live in a non-expansion state, your options may be more limited, but children and pregnant women still qualify at higher income levels. Check your state benefits page for details.

How long does it take to get approved for Medicaid?

Most states process applications within 45 days. Applications for pregnant women and children are processed within 30 days. Some states offer "presumptive eligibility," which gives you temporary coverage while your full application is being reviewed. If you need medical care right away, ask about presumptive eligibility at a hospital or community health center.

Can I choose my own doctor with Medicaid?

In most states, Medicaid works through managed care plans. When you are approved, you choose (or are assigned) a health plan that has a network of doctors, hospitals, and specialists. You can usually switch plans during the first 90 days. Some states still use a "fee-for-service" model where you can see any doctor who accepts Medicaid. Not all doctors accept Medicaid, so check with your plan or provider before scheduling.

Does Medicaid cover dental and vision?

Dental and vision coverage for adults varies by state. About 35 states offer at least some dental benefits for adults, ranging from emergency-only to full dental care. Vision coverage for adults, including eye exams and glasses, is available in many states. All children on Medicaid receive dental and vision coverage through the EPSDT benefit, which is required by federal law.

Does receiving Medicaid affect my immigration case?

Medicaid is listed as a public benefit under the public charge rule, but the current USCIS policy specifies that only long-term institutionalized care paid by Medicaid counts against you. Routine Medicaid use does not make you a public charge. Emergency Medicaid, Medicaid for children under 21, and Medicaid for pregnant women are fully exempt from public charge consideration.

Do I need to renew my Medicaid coverage?

Yes. Most states require you to renew your Medicaid coverage once per year. Your state will send you a renewal notice before your coverage period ends. Many states now use "ex parte" renewals that automatically check your income using tax data and other records. If the state can confirm you still qualify, your coverage renews without any action from you. If they cannot verify, you must submit updated income and household information to keep your coverage.