What Is Medicaid?

More than one-third of Americans lack access to quality healthcare, according to the West Health-Gallup Healthcare Affordability Index.^[1] Medicaid is a government program that provides people and families with low income with access to necessary healthcare services.

Here’s what you should know about how Medicaid works, what it covers, who qualifies, and recent legislative changes that could affect your eligibility.

What is Medicaid?

Medicaid is a joint federal and state health insurance program for people with low income. While the federal government sets mandatory guidelines, each state administers its own Medicaid program.^[2]

Medicaid programs cover benefits such as essential medical care, emergency services, long-term care, and children’s health services. Many states also provide additional coverage, like dental or vision, that goes beyond federal requirements.

Medicaid vs. Medicare: How they differ

Medicare and Medicaid are both government health insurance programs, but they serve different groups. Medicare is for people aged 65 and older, and some people with specific disabilities or medical conditions, regardless of income. Medicaid, on the other hand, serves low-income households.

Some people qualify for both health insurance programs at the same time, like low-income seniors or people with disabilities.^[3] For dual-eligible people, Medicare usually covers primary expenses. Then, Medicaid steps in to cover out-of-pocket costs, like premiums, deductibles, and copays, and services that Medicare doesn’t cover, such as long-term care.

How Medicaid works

Medicaid acts as the primary health insurance for people who qualify. It helps low-income households pay for medically necessary healthcare services.

Both federal and state governments fund Medicaid, with federal contributions typically covering at least 50% of costs.^[4] States with a lower average per-capita income receive a higher federal match. States also fund their share with taxes on healthcare providers and help from local governments.

Who qualifies for Medicaid?

Medicaid eligibility requirements vary by state but generally depend on your income, household size, and other factors, like age, disability status, or pregnancy.

You may qualify for Medicaid if you fall into one of these groups:

• Low-income households

• Pregnant people

• Children

• People receiving Supplemental Security Income (SSI)

The Affordable Care Act (ACA) allowed states to expand Medicaid to include adults earning up to 138% of the federal poverty level (FPL) or $21,597 for one person in 2025.^[5]

Always check your state’s guidelines for the most accurate eligibility details.

What Medicaid covers

Federal rules require state Medicaid programs to cover these baseline healthcare services:

• Emergency hospital services

• Transportation to medical appointments

• Physician service, nurse midwife, and nurse practitioner services

• Preventive care

• Lab and X-ray services

• Nursing facility services

• Home health services

• Children’s health screenings and medically necessary follow-up care

• Family planning services

• Services at federally qualified health centers and rural clinics

States can add extra benefits. For example, Rhode Island’s Medicaid program covers optometry, and Hawaii covers dental services. All states also offer at least some outpatient prescription drug coverage benefits, though the specific drugs covered vary by state.^[6]

What Medicaid won’t cover

Medicaid covers medically necessary healthcare services for low-income groups. Elective, nonessential, and non-FDA-approved services are typical exclusions.

Examples include:

• Cosmetic surgery

• Nonprescription drugs or supplements

• Experimental or investigational treatments

• Elective abortions

• Personal comfort items (private rooms in hospitals, TV or phone rentals)

• Alternative therapies and procedures

Optional coverage and exclusions may vary by state, so check your state’s Medicaid website for complete details.

How Medicaid varies by state

Congress created Medicaid alongside Medicare through the Social Security Amendments of 1965. In 1997, Congress passed the Children’s Health Insurance Program (CHIP) for children in households with incomes too high for Medicaid but too low for private insurance. 

Each state runs its own program and can decide who qualifies, which optional services to cover, and how providers get paid.

In 2014, the ACA gave states the choice to expand Medicaid to more low-income adults. As of 2025, 40 states and Washington, D.C., have expanded Medicaid, while 10 states haven’t.

Here’s a quick look at Medicaid expansion status by state.

State	Expanded Medicaid?	Implementation Date
Alabama	No	--
Alaska	Yes	Sept. 1, 2015
Arizona	Yes	Jan. 1, 2014
Arkansas	Yes	Jan. 1, 2014
California	Yes	Jan. 1, 2014
Colorado	Yes	Jan. 1, 2014
Connecticut	Yes	Jan. 1, 2014
Delaware	Yes	Jan. 1, 2014
District of Columbia	Yes	July 1, 2010
Florida	No	--
Georgia	No	--
Hawaii	Yes	Jan. 1, 2014
Idaho	Yes	Jan. 1, 2020
Illinois	Yes	Jan. 1, 2014
Indiana	Yes	Feb. 1, 2015
Iowa	Yes	Jan. 1, 2014
Kansas	No	--
Kentucky	Yes	Jan. 1, 2014
Louisiana	Yes	July 1, 2016
Maine	Yes	Jan. 10, 2019
Maryland	Yes	Jan. 1, 2014
Massachusetts	Yes	Jan. 1, 2014
Michigan	Yes	April 1, 2014
Minnesota	Yes	Jan. 1, 2014
Mississippi	No	--
Missouri	Yes	Oct. 1, 2021
Montana	Yes	Jan. 1, 2016
Nebraska	Yes	Oct. 1, 2020
Nevada	Yes	Jan. 1, 2014
New Hampshire	Yes	Aug. 15, 2014
New Jersey	Yes	Jan. 1, 2014
New Mexico	Yes	Jan. 1, 2014
New York	Yes	Jan. 1, 2014
North Carolina	Yes	Dec. 1, 2024
North Dakota	Yes	Jan. 1, 2014
Ohio	Yes	Jan. 1, 2014
Oklahoma	Yes	July 1, 2021
Oregon	Yes	Jan. 1, 2014
Pennsylvania	Yes	Jan. 1, 2015
Rhode Island	Yes	Jan. 1, 2014
South Carolina	No	--
South Dakota	Yes	July 1, 2023
Tennessee	No	--
Texas	No	--
Utah	Yes	Jan. 1, 2020
Vermont	Yes	Jan. 1, 2014
Virginia	Yes	Jan. 1, 2019
Washington	Yes	Jan. 1, 2014
West Virginia	Yes	Jan. 1, 2014
Wisconsin	No	–
Wyoming	No	--

2025 changes to Medicaid

The One Big Beautiful Bill Act (OBBBA), signed into law by the Trump administration, has major implications for states, enrollees, and healthcare providers, including:

• Reduction of federal funding: Federal funding cuts may force states to consider limiting the number of people with coverage, cutting optional benefits, and reducing funding to healthcare facilities and staff.

• New work requirements: Adults enrolling through the ACA Medicaid expansion must complete at least 80 hours of qualified work activities per month, which could affect coverage for adults with disabilities or others facing barriers to employment.

• Funding cuts for family-planning facilities: OBBBA prohibits federal funding for community providers offering family planning, reproductive health, and abortion services, such as Planned Parenthood.

• Medicaid barriers for immigrants: The bill reduced the federal match rate for states covering undocumented immigrants, including children and pregnant adults without lawful status. The provision also requires lawfully residing immigrants to wait five years after obtaining qualified status before they become eligible for Medicaid.

• Limits on healthcare provider taxes: OBBBA limits the state’s use of provider taxes to generate revenue for Medicaid. Enrollees may experience reduced access to healthcare services or longer wait times due to funding constraints.

• More frequent eligibility checks: The bill requires states to perform eligibility checks every six months (instead of annually) for Medicaid expansion enrollees. Enrollees may face more frequent disruptions to coverage if they fail to provide the required documentation on time.

How to apply for Medicaid

You can enroll for your state’s Medicaid program at any time. It even covers up to three months retroactively before your application date.

Here’s a look at the application process:

• 

  1. Apply online, by mail, in person, or by phone

  Visit your state Medicaid program’s website, or start an application at Healthcare.gov.

• 

  2. Gather important documents

  You’ll need names and birthdates, proof of income (like paystubs or W-2s), Social Security numbers, and proof of citizenship or immigration status for everyone applying.

• 

  3. Wait for a response

  Your state agency will review your application and contact you if it needs more details. If approved, you’ll receive a Medicaid card in the mail — or digitally.

Be sure to check your state’s guidelines, as they may have additional eligibility requirements or documents you’ll need to provide.

Medicaid FAQs