What Is Medicaid, and Who Is Eligible?
This national program is the single biggest source of health care coverage in the country.
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Senior Editor & Content Strategist Medicaid is a government program that provides free or low-cost health insurance to roughly 70 million people . This includes certain low-income adults, pregnant people, children, seniors and people with disabilities. Medicaid covers about 1 in 5 Americans, making it the single biggest source of health insurance in the U.S.
Medicaid is jointly funded by state and federal governments. It’s managed by states, so coverage and eligibility vary.
Medicaid eligibility
Eligibility for Medicaid varies by state, but the following rules traditionally apply:
- You must be a resident of the state in which you’re applying.
- Your financial situation would typically be defined as low income or very low income.
- You must be a U.S. citizen or a qualified noncitizen, such as a lawful permanent resident.
States are legally required to cover certain groups of people. These include low-income families, qualified pregnant people, children, people with disabilities, older adults and people getting Supplemental Security Income, or SSI. (See the full list of groups with mandatory eligibility.)
Other coverage categories are optional, and states can choose whether they’ll cover those individuals.
Thanks to the Affordable Care Act of 2010, most states have expanded Medicaid coverage to almost all low-income Americans under age 65 (including those with no minor children). The ten states that haven’t expanded coverage are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.
What is the income limit for Medicaid in 2026?
In states with expanded coverage, adults with income at or below 138% of the federal poverty limit (FPL) qualify for Medicaid. Children are covered up to this income level or higher in all states.
Because Medicaid eligibility is based on your current situation, it’s often easiest to look at your current monthly income. Here are the federal poverty levels and estimated Medicaid income limits in most states :
| Federal poverty level in 2026 (Annual) | Monthly Medicaid income limit (138% FPL)* |
|---|---|
| $15,960 for individuals | $1,836 |
| $21,640 for a family of 2 | $2,489 |
| $27,320 for a family of 3 | $3,142 |
| $33,000 for a family of 4 | $3,795 |
| $38,680 for a family of 5 | $4,449 |
| *These income limits only apply in states with expanded coverage. | |
You may still qualify for Medicaid if your income is above these limits. For example, many states cover pregnant people and children with higher incomes — up to 200% of the FPL or more.
» MORE: Not eligible for Medicaid? Compare health insurance quotes
What Medicaid covers
Under federal law, state Medicaid programs have to cover certain services. Many state Medicaid programs choose to cover optional services. Here’s a breakdown of some of the covered benefits :
| Covered in all states: | Covered in some states: |
|---|---|
|
|
| *This isn’t a required benefit, but all states currently cover it. | |
You can check the full list of mandatory and optional benefits.
How to apply for Medicaid
The process to apply for Medicaid will depend on your state. Here’s a step-by-step guide to figuring out the application process in your state.
1. Gather your documents.
Here’s some information you’ll likely be asked for when you apply :
Identification
- A form of government-issued ID.
- Proof of immigration status or citizenship.
Income and expenses
- Paystubs, W-2s or other documents confirming your income.
- A list of your monthly payments like rent, mortgage, utilities and loan payments.
Other benefits
- Verification of any government benefits you already receive.
- Plan information if you’re currently insured or your employer offers health insurance.
2. Look up your state’s Medicaid program.
Medicaid program names vary by state. Check the name in your state. Then, search for eligibility and application information for your state’s program.
3. Submit your application.
Typically, you can apply through the health insurance marketplace or your state Medicaid office.
- Applying through the health insurance marketplace: Visit HealthCare.gov to see if you qualify for Medicaid in your state. If you fill out an application and you or someone in your household qualifies for Medicaid, the state agency will get in touch.
- Applying through your state Medicaid office: Find your state agency’s website. From there, you can read about eligibility and apply for benefits.
How much does Medicaid cost?
Medicaid is often free, but some states may charge premiums and enrollment fees. Depending on where you live, Medicaid may also include copays, coinsurance and deductibles.
There’s a limit on out-of-pocket costs, but people with higher incomes may face higher charges. Some people, like children and those in hospice care, are exempt from out-of-pocket costs.
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What’s the difference between Medicare and Medicaid?
Medicaid and Medicare are both government-run health care programs. But they serve different populations:
- Medicare provides health insurance mainly to people ages 65 and older, no matter their income level. It’s a federal program, so eligibility and coverage are the same everywhere.
- Medicaid provides health insurance to low-income and vulnerable people of all ages. Eligibility and benefits vary by state.
Can you have both? It’s possible to qualify for both Medicaid and Medicare. This is called being “dually eligible.” In this case, Medicaid may help pay for premiums and out-of-pocket costs associated with Medicare.
For more information about Medicaid, visit Medicaid.gov or contact your state Medicaid agency.
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- 1. Medicaid.gov. November 2025 Medicaid & CHIP Enrollment Data Highlights. Accessed Mar 16, 2026.
- 2. HealthCare.gov. Federal poverty level (FPL). Accessed Mar 16, 2026.
- 3. Medicaid.gov. Mandatory & Optional Medicaid Benefits. Accessed Mar 16, 2026.
- 4. USA.gov. How to apply for Medicaid and CHIP. Accessed Mar 16, 2026.
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