What You Need To Know About Medicaid

Quick Answer

Medicaid is a joint federal and state program that provides free or low-cost health coverage to eligible low-income individuals and families. As of April 28, 2026, over 80 million Americans are enrolled, and income eligibility is generally set at 138% of the federal poverty level in expansion states.

Insurance is expensive, and most people don’t have the means to cover the exorbitant cost. Several government programs can help provide financial relief for those in need but consider this your starting point: Medicaid.

Key Takeaways

Medicaid is jointly funded by state and federal governments and currently covers more than 80 million low-income Americans, according to Medicaid.gov enrollment data.
In states that adopted the Affordable Care Act’s Medicaid expansion, eligibility extends to adults earning up to 138% of the federal poverty level, as outlined by the Centers for Medicare and Medicaid Services (CMS).
Most states cap countable assets at $2,000 for an individual when determining Medicaid eligibility for long-term care programs, per KFF (Kaiser Family Foundation).
Medicaid does not cover cosmetic procedures, and prescription drug coverage outside of specific qualifying populations is generally handled through Medicare Part D, according to Medicare.gov.
Pregnant women may qualify for Medicaid coverage immediately upon a doctor’s eligibility determination, with postpartum coverage now extended to 12 months in many states following the American Rescue Plan Act, per KFF’s postpartum coverage tracker.
The federal share of Medicaid spending, known as the Federal Medical Assistance Percentage (FMAP), ranges from 50% to 83% depending on the state’s per capita income, as reported by the Center on Budget and Policy Priorities (CBPP).

What is Medicaid
Medicaid is a program funded by state and federal governments that can be used for medical coverage for low-income individuals. Administered at the federal level by the Centers for Medicare and Medicaid Services (CMS), the program provides a critical safety net for millions of households. With these funds, insurance plan costs are lower than typically paid out by employers or investors with limited access to resources.

Medicaid is a risk-sharing program; if the patient cannot pay back the costs, the state will pick up the tab. It is a subsidy healthcare program that helps cover low-income families and individuals. According to the Center on Budget and Policy Priorities (CBPP), the federal government’s share of Medicaid costs — called the Federal Medical Assistance Percentage, or FMAP — never falls below 50%, meaning states always have a funding partner. If you are eligible for Medicaid, you are likely to qualify for other assistance programs.

Medicaid is the backbone of the American healthcare safety net. For low-income families, it’s often the only thing standing between them and catastrophic medical debt. Understanding your state’s specific rules is the single most important step anyone can take before applying,

says Dr. Sara Rosenbaum, JD, Harold and Jane Hirsh Professor of Health Law and Policy at George Washington University’s Milken Institute School of Public Health.

Who is Eligible for Medicaid
You should have a low income and be a U.S. citizen or a lawful permanent resident with very little assets, which means you may not have access to other health insurance options. Under the Affordable Care Act (ACA) Medicaid expansion, most states have extended eligibility to non-elderly adults with incomes up to 138% of the federal poverty level. You’ll also need to be over 65 years of age in certain categories, and as of 2001, Medicaid was required to pay for the full cost of treatment for long-term care, but most states decided against this regulation in exchange for federal funds.

A pregnant woman can qualify for Medicaid once she’s been determined eligible by her doctor. Importantly, many states have now adopted extended postpartum coverage lasting 12 months after birth, a change authorized by the American Rescue Plan Act, as tracked by KFF’s postpartum coverage extension tracker. If she’s already given birth under the prior rules, she would have had to wait until after her six-week postpartum checkup to determine eligibility, though the 12-month extension now applies broadly in participating states.

Eligibility Category	Income Limit (% of Federal Poverty Level)	Asset Limit (Typical)	Notes
Adults (Expansion States)	Up to 138% FPL	No asset test	Applies in the 40+ states that adopted ACA expansion
Adults (Non-Expansion States)	Varies; often 50–75% FPL	No asset test in most cases	Narrower eligibility; check your state’s rules
Children (CHIP/Medicaid)	Up to 200–300% FPL	No asset test	Covered under Medicaid or the Children’s Health Insurance Program (CHIP)
Pregnant Women	Up to 185–200% FPL (varies by state)	No asset test	Postpartum coverage extended to 12 months in most states
Seniors and People with Disabilities	Up to 100% FPL (SSI-related)	$2,000 individual / $3,000 couple	Long-term care rules apply; estate recovery possible
Dual Eligibles (Medicare + Medicaid)	Up to 100% FPL for full benefits	$2,000 individual	Medicaid may cover Medicare premiums, copays, and long-term care

How to Apply for Medicaid
If you believe you are eligible, the next step is to apply and see what happens. You can apply through your state’s Health and Family Services Department, directly through HealthCare.gov, or in person at a local Medicaid office. If you have already applied and are unsure of your current status, contact your state’s Health and Family Services Department. There may be forms you need to complete to be considered for Medicaid.

You’ll need to prove how much money you make and how much money you have saved to be considered for Medicaid. Additionally, your assets will be taken into account. You can’t have more than $2,000 worth of assets in most long-term care programs; this rule may vary by state. According to KFF, asset limits for long-term services and supports are enforced strictly, and any assets over the threshold could be subject to estate recovery by the state. Just remember, if you do have assets, they will most likely become the property of your state government if they are needed to help cover the costs of medical bills.

It’s important to have your information when you apply, such as your Social Security card, proof of income, citizenship status, etc. The Social Security Administration (SSA) coordinates closely with Medicaid for Supplemental Security Income (SSI) recipients, and in many states, SSI eligibility automatically confers Medicaid eligibility. You may also be required to provide a list of all assets and information about your spouse if you’re married.

You may also need to go through some reviews where you will be asked about your medical history and if there are any current or past medical conditions that will require coverage or care. The decision will be made in your best interests; it isn’t about what you deserve or what you can pay for. You will be screened for eligibility, and then your application may be reviewed.

If Medicaid is approved, you will have to pay the premium every year, and when you do, the state will make up the difference in those instances where your income falls short of what’s expected. If you don’t have enough money saved to cover the entire cost of care, there could be a shortfall.

And if you want to leave the program, you’ll need to make sure that you don’t owe any unpaid bills. This may not be the best option if you’re trying to pay off debt or are a credit risk. The state will contact you if your payments slip or don’t arrive on time.

After your application is processed, there will likely be some waiting period before coverage begins. This is usually a few weeks, but it could be more if the state is backlogged. Under federal rules enforced by CMS, most states are required to process applications within 45 days (or 90 days for disability-based applications). The state will contact you if your application has been denied, and there are some circumstances where this might happen.

Many applicants make the mistake of assuming Medicaid is one uniform program. In reality, it’s 50 different programs with 50 different sets of rules. Gathering your documentation ahead of time and knowing your state’s specific income and asset thresholds before you apply can save weeks of back-and-forth,

says Tricia Neuman, ScD, Senior Vice President and Executive Director of the Program on Medicare Policy at KFF (Kaiser Family Foundation).

What is Not Covered By Medicaid
Different states have different rules, but Medicaid does not cover cosmetic procedures. You also won’t be eligible for Medicaid if you can work full-time or part-time. You are either receiving unemployment benefits or living with a family member willing to help you financially.

Additionally, if you have long-term care insurance and plan to use your benefits, this will disqualify you from the program. It’s also important to note that Medicaid doesn’t provide prescription drug coverage outside of some special populations who qualify for the program. You may be able to receive prescription coverage through the Medicare Part D program, but you will need to apply for this separately. Individuals who qualify for both Medicare and Medicaid — known as “dual eligibles” — may have their Part D premiums covered by Medicaid, according to the Medicaid.gov eligibility guidelines.

Even if you are eligible for Medicaid, there may still be copays associated with your medical care. The providers who accept Medicaid will likely give you a discount on your services, but the patient may still owe an out-of-pocket expense. Federal rules generally cap Medicaid copays at $4 per service for most beneficiaries, as detailed by the Center on Budget and Policy Priorities.

It’s also important to know that some Medicaid programs allow adult children to be covered under their parents’ health insurance plan. This is true in the case of Medicaid expansion and under special circumstances; some states with “orphan” plans will also allow adult children to be covered.

Is Medicaid Right for Me?
If you are applying and are not eligible for another health insurance option, this may be your best option. Medicaid can provide you with the health care coverage you need, but there are still costs associated with this program. You should contact your state’s Department of Health and Family Services to learn more about how it works. You can also use the eligibility screening tool provided by Benefits.gov to get a preliminary sense of whether you qualify before starting the formal application process.

Emergency Care
You will be able to gain access to urgent or emergency care with your Medicaid card. Depending on your state and the specific program, you may be able to have a doctor who is not part of the network provide care. Inpatient hospitalization – There are different ways that Medicaid can help with inpatient hospitalization, depending on what the state does. Some programs may pay for a portion of the hospitalization, and others may allow you to stay at a facility paid for by the state. You may have to cover some costs, but you will be able to have your stay covered in these situations. For individuals who do not qualify for full Medicaid, Emergency Medicaid may still cover treatment for emergency medical conditions, including labor and delivery, as noted by CMS.

If you need medical care or coverage, you should act as quickly as possible and educate yourself on the process. This article covers some of the basics, but there may be other things that apply to your situation specific to your case.

Frequently Asked Questions

What is Medicaid and how does it work?

Medicaid is a joint federal and state government program that provides free or low-cost health coverage to eligible low-income individuals, families, pregnant women, seniors, and people with disabilities. The federal government sets baseline requirements, while each state administers its own program, meaning benefits and eligibility rules differ by location. The federal share of funding ranges from 50% to 83% depending on the state’s per capita income.

Who qualifies for Medicaid in 2026?

Eligibility depends on income, household size, state of residence, and category of coverage. In the more than 40 states that adopted the ACA Medicaid expansion, most adults with incomes up to 138% of the federal poverty level qualify. Other qualifying groups include children, pregnant women, seniors over 65, and people with qualifying disabilities. Non-expansion states have much narrower eligibility criteria for adults.

How do I apply for Medicaid?

You can apply through your state Medicaid agency, through HealthCare.gov, or in person at a local social services office. You will need to provide proof of income, residency, citizenship or immigration status, and Social Security information. Most states must process your application within 45 days, or 90 days if the application involves a disability determination.

What documents do I need to apply for Medicaid?

You will typically need your Social Security card, proof of income (such as pay stubs or tax returns), proof of citizenship or immigration status, a government-issued photo ID, and documentation of any assets you own. If you are married, information about your spouse’s income and assets will also be required. Having these documents ready before you apply can significantly speed up the process.

What does Medicaid cover?

Medicaid covers a broad range of services including doctor visits, hospital stays, emergency care, lab tests, X-rays, and nursing home care. Optional benefits that many states include are prescription drugs, dental care, vision care, and home health services. The exact benefits available to you depend on your state’s Medicaid plan and the eligibility category under which you qualify.

What is not covered by Medicaid?

Medicaid does not cover cosmetic procedures. Prescription drug coverage for most beneficiaries is handled separately through Medicare Part D rather than Medicaid directly. Long-term care insurance benefits may disqualify you from certain Medicaid programs. Copays may apply to some services, though they are generally capped at $4 per service under federal guidelines.

What is the Medicaid asset limit?

For long-term care Medicaid programs, most states set the asset limit at $2,000 for an individual and $3,000 for a couple, though some states use different figures. Certain assets are typically exempt, including your primary home (up to a certain equity value), one vehicle, and personal belongings. These limits do not apply to standard Medicaid for low-income adults under the ACA expansion, which generally has no asset test.

How is Medicaid different from Medicare?

Medicare is a federal health insurance program primarily for people aged 65 and older, as well as younger people with certain disabilities, regardless of income. Medicaid is an income-based program for low-income individuals of any age. Some individuals qualify for both programs simultaneously — they are called “dual eligibles” — and Medicaid may help cover Medicare premiums, deductibles, and out-of-pocket costs for those individuals.

Can I have Medicaid and other insurance at the same time?

Yes, it is possible to have both Medicaid and other health coverage simultaneously. In this case, Medicaid typically acts as the “payer of last resort,” meaning it pays after all other insurance has paid its share. Having employer-sponsored insurance does not automatically disqualify you from Medicaid if your income falls within eligible limits, though the rules vary by state.

What happens if my Medicaid application is denied?

If your application is denied, the state must notify you in writing and explain the reason for the denial. You have the right to appeal the decision, and most states have a formal hearing process for this purpose. If your income is too high for Medicaid but you still need assistance, you may be eligible for subsidized coverage through your state’s health insurance marketplace under the ACA.