What is Medicaid?
Medicaid is a joint federal-state program that provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. In 2026, Medicaid covers approximately 80 million Americans, making it the nation’s largest health insurance program by enrollment.
Who is Eligible?
Eligibility varies by state, but the Affordable Care Act established a national floor. General categories include:
Adults
- In states that expanded Medicaid: Adults with income up to 138% of the Federal Poverty Level (FPL)
- In non-expansion states: Eligibility is more restrictive
- Children’s Health Insurance Program (CHIP) covers children in families with income too high for Medicaid but too low to afford private insurance
- Generally covers children up to 200-300% FPL depending on the state
- Most states cover pregnant women with income up to 185-200% FPL
- Postpartum coverage extended to 12 months in most states
- Medicare-Medicaid dual eligibles receive coordinated coverage
- Eligibility based on income and assets
- Texas, Florida, Georgia, Alabama, Mississippi, South Carolina, Tennessee, Kansas, Wyoming, and Wisconsin
- Inpatient and outpatient hospital services
- Physician services
- Lab and X-ray services
- Family planning services and supplies
- Federally qualified health center services
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) for children
- Prescription drugs
- Dental care
- Vision care
- Home health services
- Mental health and substance use disorder services
- Physical and occupational therapy
- Decisions must be made within 45 days (or 90 days for disability-based applications)
- If approved, coverage may be retroactive up to 3 months before application date
- You must report changes in income, household size, or address
- Medicaid.gov: medicaid.gov
- Healthcare.gov: healthcare.gov
- Benefits.gov: benefits.gov
- Find Local Help: localhelp.healthcare.gov
- Families USA: familiesusa.org (consumer advocacy and enrollment help)
– 138% FPL in 2026 = ~$20,790 for a single person
Children
Pregnant Women
Seniors and People with Disabilities
Medicaid Expansion States
As of 2026, 41 states (plus D.C.) have expanded Medicaid under the ACA. States that have NOT expanded include:
In non-expansion states, many low-income adults fall into a “coverage gap” — they earn too much for traditional Medicaid but don’t qualify for ACA marketplace subsidies.
What Does Medicaid Cover?
Mandatory Benefits (All States)
Optional Benefits (Most States Offer)
How to Apply
Online
Visit Healthcare.gov or your state’s Medicaid website to apply. Most states have integrated applications.
By Phone
Call the federal Marketplace at 1-800-318-2596 or your state Medicaid agency.
In Person
Visit your local Department of Social Services, Medicaid office, or community health center.
Through a Navigator or Assister
Free enrollment help is available through certified application assisters and navigators. Find one at localhelp.healthcare.gov.
After You Apply
Renewal
Medicaid coverage must be renewed annually. States are required to use available data to automatically renew coverage when possible. If additional information is needed, the state will send a renewal form.