An Overview of Medicaid Eligibility and Benefits

Covering more than 71 million Americans, Medicaid is the largest health insurance provider in the United States. The program, created under the Social Security Act Amendments of 1965, is available to low-income individuals in the 50 states, the District of Columbia, and U.S. territories. It is a collaboration between federal and state governments to provide coverage for basic health care.

Understanding how Medicaid works can help you to make the most of its benefits.

What Medicaid Covers

Medicaid does not necessarily cover everything, but it covers a lot. The federal government requires that certain services be offered to all Medicaid beneficiaries.

These mandatory services include the following:

• Hospital care, including inpatient and outpatient
• Care provided in community health centers and rural health clinics
• Care provided in nursing facilities for people 21 years of age and older
• Care provided by physicians, nurse midwives, and nurse practitioners
• Early and periodic screening, diagnostic, and treatment (EPSDT) services
• Family planning services and supplies
• Home health care for people eligible for nursing facility services
• Laboratory and imaging services
• Transportation for medical reasons

However, each state has the option to expand on those services—and they often do. These optional services may include but are not limited to:

• Case management
• Dental care (including dentures)
• Durable medical equipment
• Hospice care
• Mental health services
• Prescription medications
• Prosthetic devices
• Rehabilitation services (including physical therapy and occupational therapy)
• Telemedicine
• Vision care (including eyeglasses)

Who Can Get Medicaid?

Many people with low incomes would be unable to afford health insurance without government assistance. This is where Medicaid comes into play. The U.S. Department of Health and Human Services (HHS) determines the federal poverty level (FPL) every year, and these values are used to set the eligibility standards for Medicaid.

All states cover certain categories of people, including low-income parents, children, pregnant women, the elderly, and people with disabilities. In addition, the Affordable Care Act added a new eligibility category for low-income adults. (This was subsequently made optional under a Supreme Court ruling; 40 states and the District of Columbia had expanded Medicaid to cover low-income adults as of 2025.)

The federal government sets certain minimum requirements, but states can increase income thresholds to include more people. As a result, each state has its own income limits for the various eligibility categories, and there's significant variation from one state to another.

You can learn more information about what your state program covers on the Medicaid.gov website.

Immigration Status and Eligibility

Being an American citizen assures that you can get Medicaid coverage as long as the other requirements are also met. The same cannot be said for those with immigrant status.

Qualified non-citizens (lawfully present immigrants) are generally eligible for Medicaid once they meet state requirements for income and length of residency. Often, the residency requirement is five years after attaining lawful permanent residency (Green Card) status.

There are exceptions for refugees and those granted asylum, currently or before becoming lawful permanent residents (Green Card holders).

Immigrants who have entered the country illegally may be eligible for emergency services only but are not eligible for federally-funded Medicaid. However, some states use only state funds to provide Medicaid to some undocumented immigrants.

Medicaid vs. Medicare

Both Medicaid and Medicare healthcare programs are regulated by the CMS, but there are many differences between them.

About 12 million people are eligible for both Medicaid and Medicare. These people are referred to as dual eligible. Medicaid helps them to pay for services that Medicare doesn't cover.

How to Enroll in Medicaid

Signing up for Medicaid can be done online through the Medicaid agency in your state. Alternatively, you can contact your local Medicaid office to apply by phone or to schedule an in-person appointment. If you are eligible, sign up as soon as possible to make the most of the benefits.

Unlike other types of health coverage, Medicaid enrollment is open year-round. And in most states, the effective date of your coverage can be backdated to the first of the month you apply, or even earlier.

Summary

Medicaid fills a crucial need of providing health coverage to low-income people in the United States. Enrollment in Medicaid is open year-round, so applications can be submitted anytime.

Medicaid covers low-income people who are children, seniors, disabled, pregnant, or parents of minor children. The income limits for these populations vary by state, and there are also asset limits for seniors and disabled applicants.

In addition to these populations, states have the option to cover low-income adults under the Affordable Care Act, with enhanced federal funding. Forty states and DC have implemented this option.