What is Medicaid and who qualifies?

Medicaid is a joint federal-state health insurance program for people with low incomes. Eligibility, benefits, and cost-sharing vary by state — in states that expanded Medicaid under the ACA, most adults with income up to 138% of the federal poverty level qualify. Medicaid is distinct from Medicare, which is based on age and disability status rather than income.

Educational content — not legal or benefits advice

ClearValue Lending is not affiliated with Medicaid, CMS, or any government agency. This page is general financial education, not benefits advice. Medicaid rules vary significantly by state. For eligibility determination and application, visit your state's Medicaid agency or apply through HealthCare.gov, which screens all applicants for both Medicaid and marketplace plan eligibility.

Medicaid is a publicly funded health insurance program jointly administered by the federal government and individual states. It provides coverage to qualifying low-income individuals including children, pregnant women, adults, seniors, and people with disabilities. Medicaid.gov is the federal resource; your state's Medicaid agency handles actual eligibility determinations and enrollment. Coverage is generally free or very low cost for enrollees.

Who qualifies — ACA Medicaid expansion

The ACA gave states the option to expand Medicaid to cover most adults with income up to 138% of the federal poverty level (FPL) — approximately $20,120/year for a single person in 2024 (federal poverty guidelines adjust annually). As of 2025, the majority of states have adopted expansion. In expansion states, coverage is available to most non-elderly adults based on income alone, regardless of disability or family status. In non-expansion states, eligibility is more restricted — typically tied to specific categories (children, pregnant women, certain adults with disabilities). KFF's Medicaid expansion status map tracks the current status of every state.

What Medicaid covers

Federal law requires Medicaid programs to cover a core set of benefits: inpatient and outpatient hospital services, physician services, lab and X-ray services, FQHC services, nursing facility care, home health services, rural health clinic services, and nurse midwife/family planning services. States may add optional benefits — dental, vision, prescription drugs (nearly all states cover these), mental health, and long-term services and supports. Benefits and cost-sharing structures vary significantly by state.

Medicaid vs. Medicare

Medicaid = income-based. For low-income individuals and families. Run jointly by states and the federal government. Generally free or very low cost.
Medicare = age/disability-based. For people 65+ and certain younger people with qualifying disabilities. Federal program. Has premiums, deductibles, and cost-sharing.
Some people qualify for both — they are called 'dual eligibles.' Medicaid typically pays Medicare cost-sharing for dual-eligible beneficiaries.

How to apply

You can apply for Medicaid through your state's Medicaid agency or through HealthCare.gov (which screens applicants for both Medicaid and marketplace plans). HealthCare.gov routes you to your state's Medicaid program if you appear eligible. There is no fixed open enrollment window for Medicaid — you can apply any time of year. If you qualify, coverage can start quickly.

CMS and KFF sources

The ACA allowed states to expand Medicaid to nearly all adults with incomes at or below 138% of the federal poverty level. As of 2025, the majority of states have adopted the Medicaid expansion. — KFF — Status of State Medicaid Expansion Decisions
Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. — Medicaid.gov — Medicaid Overview

Key takeaways

Medicaid covers low-income individuals and families — in expansion states, most adults up to 138% FPL qualify.
Medicaid ≠ Medicare. Medicaid = income-based; Medicare = age/disability-based. Some people qualify for both ('dual eligible').
Coverage is free or very low cost in most states; benefits vary by state but must meet federal minimums.
You can apply anytime — no open enrollment window. Apply through HealthCare.gov or your state's Medicaid agency.
If you lost income significantly, check Medicaid eligibility before paying for COBRA or marketplace coverage.