What is Medicaid?
Medicaid is a healthcare insurance program for Americans with limited income, and in some cases, limited financial assets. Medicaid is available nationwide, but coverage and eligibility rules vary from one state to another, as the program is jointly run by the federal and state governments (unlike Medicare, which is fully funded by the federal government, and thus very consistent throughout the country).
Click on your state on this map to see more details about the Medicaid program, including how the state has handled the ACA’s Medicaid expansion.
How many Americans are enrolled in Medicaid?
As of September 2022, there were nearly 91 million people enrolled in Medicaid and Children’s Health Insurance Program (CHIP) coverage in the United States. Most are enrolled in Medicaid, although 7 million are enrolled in separate CHIP coverage. Including separate CHIP and Medicaid, children account for about 45% of the 91 million enrollees (some states administer CHIP separately, while others offer it as part of their Medicaid program).When did the Medicaid program start?
Medicaid became federal law in 1965, as part of Title XIX of the Social Security Act. Coverage became available in 1966, with about 4 million people enrolled in the program that year. But since it’s a joint program between the federal and state governments, states adopted the program at different times. Arizona was the last state to create a Medicaid program, doing so in 1982. Medicaid has been available nationwide since 1982.Who is eligible for Medicaid?
Medicaid eligibility is based on income, but some populations also have to meet asset limits. Medicaid eligibility is also based on immigration status; for most types of Medicaid coverage, a person must be either a United States citizen or have lawfully resided in the U.S. for at least five years in order to qualify (some states use state funds to provide Medicaid to recent immigrants or even undocumented immigrants, particularly children and pregnant women).
The Affordable Care Act expanded eligibility and eliminated asset tests for some populations, including children, pregnant women, and adults under the age of 65. For these populations, eligibility requirements are based on an ACA-specific version of modified adjusted gross income (MAGI), with income limits that vary by category and state.
Under Medicaid expansion rules, a single adult under the age of 65 is eligible for Medicaid in most states (some states still haven’t implemented Medicaid expansion) with an income of $18,754 in 2022 (this will increase to $20,120 once states begin using the 2023 poverty level numbers in the first few months of 2023). This amount is 138% of the federal poverty level, based on an eligibility cap of 133%, plus a 5% income disregard).How do I apply for Medicaid?
You can apply for Medicaid through your state’s Medicaid office. If you’re eligible for MAGI-based Medicaid, you can also apply through your state’s health insurance marketplace/exchange. In most states, that’s HealthCare.gov, although DC and 17 states run their own marketplace website. If the marketplace or state agency determines that you’re eligible for Medicaid, they’ll give you information on how to proceed to complete your enrollment.
What does Medicaid cover?
Medicaid benefits vary by state and by age (for example, certain services, such as dental and vision care, have to be provided to children but are not required to be covered for adults). Some benefits are mandatory under federal rules (including things like inpatient and outpatient hospital services, labs and x-rays, and family planning services), while others are optional and states can decide whether to provide them as part of their Medicaid programs (optional benefits include some healthcare services that are considered essential health benefits under private individual and small group health plans, including things like prescription drugs and physical therapy).
Medicaid covers the costs for more pregnancies in the U.S. than any other insurance payer, covering about 42% of all births (in some states, it’s more than 60%). And unlike Medicare, Medicaid does cover long-term care, and the majority of nursing home residents in the U.S. are covered under Medicaid (most also have Medicare, which covers their medical care).
