What Is Medicaid?

“People tend to use the terms interchangeably, but they are not at all the same,” says Josh Hodges, the chief impact officer at the National Council on Aging in Arlington, Virginia.

One thing is the same, though: For millions of families, Medicaid provides a critical safety net that makes healthcare accessible to people who would not be able to afford it otherwise. Here’s what you need to know.

How Does Medicaid Work?

• Doctors’ visits and hospital care
• Preventive care like checkups and vaccines
• Lab tests and X-rays
• Prenatal and maternity care
• Mental health services
• Transportation to medical appointments
• Emergency services

• Eligibility rules
• Application processes
• Additional services such as dental care and physical therapy
• Provider reimbursement rates

Who Qualifies for Medicaid?

Financial Eligibility

Medical Eligibility

In some states, if you have very expensive medical bills, but your income is higher than the Medicaid requirements, you may still qualify for the program if your healthcare expenses exceed a certain amount, called the medically needy income limit.

Special Circumstances Eligibility

Are There Different Types of Medicaid?

While Medicaid is often discussed as a single program, there are, in fact, different types, each of which provides coverage through different pathways.

• Traditional Medicaid This program exists in every state, plus DC and all U.S. territories. It covers children, pregnant women, parents with dependents, adults 65 and older, and people with disabilities based on their income and household size.

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• Expansion Medicaid This program covers adults under the age of 65 in 40 states and DC who have an income that’s no more than 138 percent of the Federal Poverty Level. In 2026, that amount is about $22,025 annually for a single person and about $45,540 for a household of four.

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• Long-Term Care Medicaid Even though more than 60 percent of all nursing home residents are covered by Medicaid, most Americans are unaware that Medicaid covers this type of care.

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How Do I Know if I’m Eligible?

You can determine your eligibility for Medicaid by entering your state and household size on HealthCare.gov or contacting your state Medicaid agency directly.

Where and How Do I Sign Up?

• State Medicaid Agency Apply online, by phone, or in person in your state’s Medicaid office.
• Healthcare.gov Go to Healthcare.gov to apply. If you qualify, your application will be forwarded to your state Medicaid agency.
• Automatic Enrollment In 34 states and DC, Supplemental Security Income (SSI) recipients are automatically enrolled.

How Much Will It Cost Me?

For nursing home care, Medicaid can cover 100 percent of the costs, including rooming, meals, and medical supplies. But you’ll need to contribute nearly all your income toward these costs first, keeping only a small personal needs allowance (PNA), which varies by state.

“Individuals with [Medicare and] Medicaid coverage are also eligible for ‘Extra Help,’ a Medicare program that reduces drug costs,” says Kertesz.

How Do I Know Which Doctors Accept Medicaid?

What Do I Do if I Lose My Benefits?

• Understand why you lost coverage. States regularly check your eligibility for Medicaid. If your income (or other factors) make you ineligible, your coverage may end. If you’ve received a notice or request from your state, don’t ignore it — respond quickly to avoid losing coverage unnecessarily.
• Document meeting the new work requirements and renew your coverage. By January 1, 2027, adults covered through Medicaid expansion programs must show 80 hours a month of work, school, or community activities, with some exceptions. This group of people must also renew their coverage every six months instead of annually.
• Reapply for Medicaid. If you believe there was a mistake, reapply — you can do so anytime your income or circumstances change.
• Apply for Marketplace coverage. Plans on the Health Insurance Marketplace, a government-run platform for finding health insurance, offers options for those transitioning off Medicaid. Depending on your income, you may qualify for premium tax credits or cost-sharing subsidies. You can apply up to 60 days before Medicaid ends or within 90 days after it ends, with coverage starting the next month.
• Get free help. Marketplace assisters can explain your health coverage options and help you apply for free. Visit HealthCare.gov to find local help or contact the Marketplace Call Center at 800-318-2596.

Can I Have Medicaid and Other Insurance?

Yes, Medicaid can work alongside other health coverage you may have.

• Private health insurance
• Medicare
• Employer-sponsored plans
• Workers’ compensation
• Court-ordered health coverage

When you have Medicaid plus another form of health coverage, know that:

• Medicaid pays last. Medicaid acts as a secondary payer, covering what your other plan doesn’t, including copays, deductibles, or remaining balances. So if you’re on Medicare, too, “Medicaid will pick up your Medicare deductible and copays,” says Sandy Kemp, a registered Social Security analyst in Las Vegas.
• Medicaid coordinates with other coverage. If your other insurance is responsible for part of a medical bill, Medicaid works directly with that insurer to make sure your providers are paid.
• Drug benefits are coordinated. If you have both Medicare and Medicaid, you’ll be automatically enrolled in Medicare Extra Help, which covers your medication costs in addition to Medicaid.

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