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Medicaid

A joint federal and state program, administered by each state within federal rules — so eligibility, benefits and even the program's name vary by where you live.

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Medicaid at a glance

Who runs it
A joint federal and state program, administered by the states.
Why it varies
Federal law requires certain groups to be covered; states may cover others and administer the program themselves.
What eligibility can depend on
Income, household circumstances, age, pregnancy, disability and other category rules, depending on the state.
When you can apply
At any time of year, through your state agency or a Marketplace application.

What is medicaid?

Medicaid is a joint federal and state program that, together with the Children's Health Insurance Program, provides health coverage to tens of millions of people in the United States. The federal government sets requirements and shares the cost; each state runs its own program within those requirements.

That structure is the reason almost every specific question about Medicaid has a state-level answer. Two people with identical circumstances in different states can reach different outcomes, and some states run their program under a different name entirely.

How it works

  1. Step 1

    Federal framework

    Federal law requires states to cover certain groups and sets the rules the program has to work within.

  2. Step 2

    State administration

    Each state administers its own program, chooses among the optional coverage groups, and handles applications and renewals.

  3. Step 3

    The program where you live

    What that adds up to — who is eligible, what is covered, what it is called — is specific to your state.

How eligibility is structured

Medicaid eligibility is built from categories rather than a single income line, which is why a national figure would mislead more than it explains.

  • Mandatory and optional groupsFederal law requires states to cover certain groups — Medicaid.gov gives low-income families, qualified pregnant women and children, and people receiving Supplemental Security Income as examples. States have further options and may cover additional groups.
  • Income, counted in a defined wayModified adjusted gross income is the basis for determining Medicaid income eligibility for most children, pregnant women, parents and adults.
  • Some eligibility is not income-tested the same wayPeople whose eligibility is based on blindness, disability or being 65 or older are exempt from the MAGI-based income counting rules.
  • Expansion is a state choiceStates were given the option to extend eligibility to adults below a federal income level. Most have done so, and states that have not may still choose to.
Nothing on this page determines whether you are eligible, and no figure here is offered as a threshold. Eligibility is decided by your state Medicaid agency on an application.

How it relates to Marketplace coverage

Marketplace financial assistance and Medicaid are separate systems with separate rules, connected at the point of application.

  • One application looks at bothA Marketplace application indicates whether you or your children may qualify for Medicaid or CHIP rather than a Marketplace plan with savings.
  • Which one applies depends on circumstancesDepending on income, household circumstances and your state, an application can point toward Medicaid rather than toward a Marketplace plan.
  • Medicaid and CHIP are not limited to Open EnrollmentYou can apply at any time of year, and coverage can begin once an application is approved.

How Marketplace coverage works

Where to apply, and who decides

Two routes, one decision-maker. Whichever route you use, the determination is your state's.

  • Your state Medicaid agency, which administers the program and makes eligibility determinations.
  • A Marketplace application at HealthCare.gov, which indicates whether you appear to qualify and sends the application on.
  • Medicaid.gov is the federal starting point and links to each state's program.

Common misconceptions

Each of these is repeated often enough to be worth answering directly.

  • Often heard

    There is one national Medicaid income limit.

    In practice: Eligibility is built from categories and administered state by state, and the income rules differ by group. A single national figure would be wrong for most people who read it.

  • Often heard

    Medicaid and Marketplace savings are the same program.

    In practice: They are separate systems with separate rules. One Marketplace application can indicate which of them appears to apply to your household.

  • Often heard

    You can only apply during Open Enrollment.

    In practice: Medicaid and CHIP applications are accepted at any time of year.

Common questions

Do I qualify for Medicaid?
This page cannot tell you, and no page should: eligibility depends on your income, your household, your state and which category you would qualify under. Your state Medicaid agency makes the determination, and a Marketplace application will also indicate whether you appear to qualify.
Why does what I read about Medicaid not match my state?
Because states administer their own programs within federal rules and make different choices about optional coverage groups. Anything specific — what is covered, what it is called, how to apply — is a state-level answer.
Can I have Medicaid and other coverage at the same time?
It happens, including with Medicare. How the coverage coordinates depends on the programs involved and on your state's rules.

Sources

  1. 1.Medicaid eligibility policy — Centers for Medicare & Medicaid Services (accessed Sep 2026)
  2. 2.Medicaid.gov — the official federal Medicaid site — Centers for Medicare & Medicaid Services (accessed Sep 2026)
  3. 3.Save on your Marketplace premiums — Centers for Medicare & Medicaid Services (accessed Sep 2026)
  4. 4.HealthCare.gov — the official Health Insurance Marketplace site — Centers for Medicare & Medicaid Services (accessed Sep 2026)

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