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What is Medicaid?
Medicaid is a federal and state program that provides health care coverage to people who qualify. Each state runs its own Medicaid program, but the federal government has rules that all states must follow. The federal government also provides at least half of the funding for their Medicaid requirements.
Based on federal regulations, states create and run their own Medicaid program to best serve its residents who qualify. States may choose to provide more services than the federal government requires and they may also choose to provide coverage to larger groups of people. Medicaid provides health care coverage for people who qualify, based on income and the value of what they own.
The history of Medicaid
Medicaid began as part of the Social Security Act of 1965. The original law gave states the option of receiving federal funding to help provide health care coverage to children whose families have a low income, their caregiver relatives, people who are blind and people who are disabled. Over time, the federal government has strengthened the rules and requirements for state Medicaid programs.
Each state decides the full range of benefits that it covers under Medicaid
Who does Medicaid serve?
Medicaid programs serve specific groups of people, including:
- Pregnant women with low income
- Children of low-income families
- Children in foster care
- People with disabilities
- Seniors with low income
- Parents or caregivers with low income
States can also choose to expand eligibility to other groups, such as people with low income who may or may not have children.
Learn about Medicaid plans
With Medicaid, there may be several types of low-cost or no-cost plans available, depending on the state where you live. Learn about the types of plans below.
|What it covers
|Low-cost or no-cost health insurance coverage that is managed by each state. Eligibility requirements can change from state to state. Your state may even have its own name for its Medicaid program.
|Insurance coverage for people who qualify for both Medicare and Medicaid. Most dual plans give you more benefits than you get with Original Medicare.
|Low-cost or no-cost coverage for infants, children and teens. Designed to help children get the care they need as they develop.
Medicaid by the numbers
76.4 million individuals enrolled in Medicaid and CHIP
69.7 million individuals enrolled in Medicaid
6.6 million individuals enrolled in CHIP
What care services are covered by Medicaid?
Each state decides the full range of benefits that it covers under Medicaid. Federal law requires that states must provide certain benefits, which are called mandatory benefits. States may also choose to offer other benefits and services by Medicaid. These are called optional benefits. The chart below shows what are mandatory benefits and what are optional Medicaid benefits.
Mandatory Medicaid benefits:
- Inpatient hospital services
- Outpatient hospital services
- Early and periodic screening, diagnostic and treatment services (EPSDT)
- Nursing facility services
- Home health services
- Physician services
- Rural health clinic services
- Federally qualified health center services
- Laboratory and X-ray services
- Family planning services
- Nurse midwife services
- Certified pediatric and family nurse practitioner services
- Freestanding birth center services (when licensed or otherwise recognized by the state)
- Transportation to medical care
- Tobacco cessation counseling for pregnant women
Optional Medicaid benefits:
- Prescription drugs
- Clinic services
- Physical therapy
- Occupational therapy (thinking and movement)
- Speech, hearing and language disorder services
- Respiratory (breathing) care services
- Other diagnostic, screening, preventive and rehabilitative services
- Podiatry (foot care) services
- Optometry (vision) services
- Dental services
- Prosthetics (to replace missing or damaged body parts)
- Chiropractic services
- Other practitioner services
- Private duty nursing services
- Personal care
- Case management
- Services for individuals age 65 or older in an institution for mental disease (IMD)
- Services in an intermediate care facility for individuals with intellectual disability
- Self-directed personal assistance services
- Community first choice option
- TB-related services
- Inpatient psychiatric services for individuals under age 21
- Other services approved by the Secretary of Health and Human Services
- Health homes for enrollees with chronic conditions
This includes services furnished in a religious nonmedical health care institution, emergency hospital services by a non-Medicare certified hospital, and critical access hospital (CAH) Medicaid prescription drug coverage.1
Prescription drug coverage is an optional benefit under federal Medicaid law. But, as of 2020, all states include some form of prescription drug coverage under their Medicaid program. In general, most enrollees within a state Medicaid program will get prescription drug coverage.
Medicaid home health care and residential senior care coverage
Medicaid programs may also cover a variety of different Home- and Community-Based Services (HCBS) to help people stay living at home and active in their community. The level of support provided is typically based on the needs of the individual.
Examples of the types of home health care and residential senior care services provided as part of HBCS programs include:
- Personal care, like showering
- Transportation services
- Skilled nursing care
- Occupational, speech and physical therapy
- Managing diet and nutrition (healthy eating)
- Home-delivered meals
- Home chores and housekeeping
Some HCBS services, like skilled nursing care and occupational, physical or speech therapy, are delivered by qualified and, in some cases, licensed professionals. Other services, such as doing chores around the house and making meals, can be provided by family members, friends or paid caregivers.
How to apply for Medicaid
Because each state manages its own Medicaid program, eligibility varies from one state to another. If you have questions about qualifying, contact your state Medicaid agency. Or, apply online at the website for your state Medicaid agency to see if you qualify.
What type of plan am I eligible for?
Answer a few quick questions to see what type of plan may be a good fit for you.
Find Medicaid plans in your area
Medicaid or dual-eligible plan benefits can change depending on where you live. Search using your ZIP code to find the right plan to meet your health care needs.
1Benefits and features vary by plan/area. Limitations and exclusions apply.