What is Medicaid (and how it differs from Medicare)

Medicaid and Medicare are often confused — they sound similar but serve different populations:

• Medicaid is for low-income people of any age. Income-based eligibility. Operated by states using a mix of federal and state funding.
• Medicare is for people 65 and older (and some younger people with disabilities). Eligibility is based on age and work history, not income. Federally operated.

You can sometimes have both Medicaid and Medicare — that's called dual eligibility.

Medicaid is the largest source of health coverage in the US, covering more Americans than any other single program. According to KFF, Medicaid covers about 1 in 5 Americans.

Each state operates its program under a different name — Medi-Cal in California, MassHealth in Massachusetts, Apple Health in Washington, HUSKY Health in Connecticut, KanCare in Kansas, AHCCCS in Arizona, etc. See your state page for the program name where you live.

Medicaid expansion: the most important factor

The Affordable Care Act (ACA) gave states the option to expand Medicaid to cover all adults with incomes up to 138% of the Federal Poverty Level. Whether your state expanded Medicaid is the single biggest factor in your eligibility if you are an adult without children or a disability.

If you live in an expansion state (most states)

All adults with income up to 138% FPL ($21,597/year for one person in 2026; $36,777/year for a family of three) qualify based on income alone. You do not need to be pregnant, disabled, or a parent.

Expansion states (as of 2026): Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, DC, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Virginia, Washington, West Virginia.

If you live in a non-expansion state

Adults without children, who are not pregnant or disabled, generally cannot qualify for Medicaid regardless of how low their income is. This creates the so-called "coverage gap" affecting millions of Americans. Non-expansion states (as of 2026): Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming.

If you are in the coverage gap, your only options are the ACA Marketplace (where subsidies may or may not be available depending on income) or community health centers. Read our Medicaid expansion states guide for details.

2026 Medicaid income limits by category

Limits below are for the 48 contiguous states and DC. Alaska and Hawaii have higher limits. Income limits use Modified Adjusted Gross Income (MAGI) for most populations.

For exact limits in your state and household size, use our Medicaid Eligibility Calculator or check the official state directory.

Categories of Medicaid eligibility

1. Adults under expansion (where applicable)

In expansion states, adults aged 19–64 with income up to 138% FPL qualify. No other criteria required.

2. Pregnant women

All states cover pregnant women up to at least 138% FPL; most states extend coverage to 185–220% FPL or higher. Coverage typically includes prenatal, delivery, and postpartum care for at least 60 days (12 months in many states under recent expansion). See our pregnancy benefits guide.

3. Children

All states cover children up to at least 138% FPL through Medicaid. Most states extend higher coverage through CHIP (see next section).

4. Parents/caretaker relatives

In expansion states, covered up to 138% FPL. In non-expansion states, limits are often much lower — sometimes below 50% FPL.

5. Seniors (65+) and people with disabilities

Eligibility tied to SSI standards or state-specific rules. Often involves asset tests in addition to income tests. See our senior benefits guide and disability benefits guide.

6. Medically needy

Some states have "medically needy" programs that let you "spend down" income on medical expenses to qualify. Available in about 33 states.

CHIP — Children's Health Insurance Program

CHIP covers children in families with income too high for Medicaid but too low to afford private insurance. CHIP limits vary by state, generally covering kids up to 200–400% FPL.

CHIP and Medicaid for children work as a combined program in most states — your single application is considered for both. Coverage typically includes well-child visits, immunizations, dental, vision, mental health, and prescriptions.

Read our CHIP complete guide for state-by-state limits and details.

How to apply for Medicaid

Three primary application paths:

1. HealthCare.gov: When you complete a Marketplace application at HealthCare.gov, you're automatically screened for Medicaid and CHIP. If you qualify, your application is forwarded to your state.
2. Your state Medicaid agency directly: Each state has a portal. Examples: BenefitsCal (CA), myBenefits.ny.gov (NY), YourTexasBenefits (TX). See our state directory for yours.
3. In person or by phone: Visit a local Medicaid office, call your state's Medicaid hotline, or dial 211.

You can apply any time of year — Medicaid has no open enrollment period (unlike Marketplace coverage).

What Medicaid covers

Federal law requires all state Medicaid programs to cover certain "mandatory" services, including: inpatient and outpatient hospital, physician, lab and X-ray, prenatal and family planning, pediatric and family nurse practitioner services, nursing facility services for adults, home health, and EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) for children.

States may also cover "optional" services like prescription drugs (virtually all states do), dental for adults (varies — many states cover only emergencies), vision, mental health, physical therapy, and hospice.

The specific dental and vision coverage for adults varies dramatically by state. See your state page for details.

Medicaid work requirements under OBBBA

The One Big Beautiful Bill Act signed in July 2025 introduced Medicaid work requirements that are rolling out across states in 2025–2026. Under these rules, certain Medicaid expansion adults must demonstrate work, volunteer, or qualifying activity of 80+ hours per month to maintain coverage.

According to KFF's analysis, about one in five Medicaid-covered adults subject to the new work requirements also receive SNAP — and the work requirement criteria differ between the two programs, creating administrative complexity.

Exemptions exist for caregivers of dependents, pregnant women, people with serious medical conditions, and certain other categories. Check with your state Medicaid agency about implementation timing and exemptions for your situation.

Medicaid vs ACA Marketplace

The choice between Medicaid and the ACA Marketplace depends mostly on income:

• Under 138% FPL in expansion states: Medicaid is your option. Marketplace plans require you to pay full price at this income level — you cannot get Marketplace subsidies if you're Medicaid-eligible.
• 138%–400% FPL: Marketplace plans with premium tax credits. Generally affordable.
• Above 400% FPL: Marketplace plans at full price (some subsidies still available through 2026).
• Under 100% FPL in non-expansion states: Often stuck in the "coverage gap" with no subsidies available.

Use our ACA Subsidy Calculator to compare. Read our Medicaid vs Marketplace guide for a detailed comparison.

Dual eligibility (Medicaid + Medicare)

About 12 million Americans qualify for both Medicaid and Medicare ("dual eligibles" or "duals"). They typically have low income and are 65+ or disabled. Medicare covers most acute care; Medicaid wraps around to cover what Medicare doesn't (long-term care, dental, vision, premiums) and helps with Medicare cost-sharing.

If you may be dual-eligible, also explore Medicare Savings Programs (MSPs) and the Extra Help/Low-Income Subsidy for prescription drugs.

Frequently asked questions

Is Medicaid free?

For most enrollees, yes — premiums are zero and copays are minimal (often $0 to $4 per service). Some states impose small premiums for children or adults above certain income thresholds.

Can I have Medicaid in one state and apply in another if I move?

You must apply in the state where you currently live. Medicaid does not transfer between states — you reapply after moving.

Does Medicaid affect my immigration status?

For most populations, Medicaid use is not considered a "public charge" factor under current federal rules. Consult an immigration attorney for your specific situation.

Can I get Medicaid if I'm unemployed?

Yes, if your income is low enough. In expansion states, anyone with income under 138% FPL qualifies. In non-expansion states, you generally need to also be a parent of a minor child, pregnant, or have a qualifying disability. See our benefits after job loss guide.

How long does Medicaid approval take?

Federal regulations require states to process most Medicaid applications within 45 days (90 days for disability-based applications). In practice, many states process much faster.

Does Medicaid cover dental for adults?

Varies dramatically by state. About 36 states cover at least some dental services for adult Medicaid enrollees; about 14 cover only emergency dental or nothing at all.