Medicaid is a social welfare program. It provides government-funded health insurance to low-income people. The insurance covers almost all necessary medical services, which means it is comprehensive. In most cases, Medicaid is health insurance for those who qualify. Some states charge a small premium for higher-income people who qualify for Medicaid.
In addition to no premiums, there is no or very little cost-sharing (such as deductibles or co-payments).
Who Qualifies?
Each state's Medicaid system is slightly different. To qualify, you must meet low-income guidelines (and depending on your eligibility category, you may also need to have small assets to qualify for Medicaid).
These guidelines depend on a variety of factors, including your age, whether you are pregnant, and whether you have a disability.
With the Affordable Care Act expanding Medicaid, here's an overview of who is covered in most states:
• Adults under 65 whose household income does not exceed 138% of the federal poverty level (FPL)3
• Some states have stricter eligibility criteria for adults under 65. To qualify for Medicaid in these states, you must meet low-income criteria and be in a medically vulnerable group (such as pregnant women, parents/caretakers of minor children, seniors, people with disabilities, and children).
• Pregnant women and children (the income limits for these groups are generally higher than those for non-pregnant adults)
• Centers for Medicare & Medicaid Services. Eligibility levels for Medicaid, Children's Health Insurance Program, and Essential Health Plans.
People with disabilities and those over 65 with lower incomes and fewer assets As of 2024, nine states state that low income alone does not qualify you for Medicaid if you are a non-pregnant adult. These states have not expanded Medicaid under the ACA, so there are coverage gaps.
(Ten states have not expanded Medicaid, but Wisconsin does provide Medicaid to adults with poverty-level incomes, meaning there is no coverage gap in that state.)
Can immigrants qualify?
Generally, only immigrants who have lived in the U.S. legally for five years or more (and meet income eligibility requirements) can qualify for Medicaid.
But immigrants who are legally present can get premium subsidies on the Marketplace/Exchange even if their income is below the poverty line. This ensures that low-income immigrants can still get affordable coverage while they wait five years to qualify for Medicaid.
Medicaid is generally not available to undocumented immigrants, but there are exceptions. For example, short-term limited Medicaid in emergencies or emergency coverage for pregnant women. (Note that undocumented immigrants cannot enroll in private plans through the Marketplace, with or without premium subsidies.)
Medicaid eligibility varies by state. For example, several states, including California, Oregon, New York, and Connecticut, have chosen to expand Medicaid eligibility to some undocumented immigrants who meet the eligibility income standards.
Who pays for Medicaid?
Medicaid is paid for by federal and state taxes. It is administered at the state level. That's why coverage and eligibility rules vary from state to state.
If you are on Medicaid, your friends, neighbors, and fellow citizens are paying for your care with their tax dollars.
If you are on Medicaid, you will likely be treated by the same doctors at the same hospitals as someone with private health insurance.
Although Medicaid is government health insurance, most of the care that people who receive it receive comes from private businesses and health care providers. Most states contract with private insurance companies to administer the insurance. Your ID card may have the name and logo of a well-known insurance company printed on it.
Depending on the state you live in and your Medicaid eligibility category, you can apply for Medicaid through your state's ACA health insurance exchange or by contacting your state's Medicaid program directly.
Summary
Medicaid is low-cost insurance that is paid for by federal and state taxes. If you have a low income and meet other eligibility requirements, you may be eligible for Medicaid. However, each state has different rules for Medicaid.
