LEARN ABOUT 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.
Click here to learn about Medicaid eligibility in each state.
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.
Medicaid plans must include mandatory health benefits under federal law. Some Medicaid plans may offer additional, optional benefits.
Each state decides the full range of benefits that it covers under Medicaid. As a result, the populations and benefits covered by Medicaid and CHIP vary across states.
In all states, Medicaid provides health care coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states,
Medicaid also covers all low-income adults below a certain income level. This group is sometimes called “expansion adults.”
CHIP (Children's Health Insurance Program), provides low-cost insurance for children whose families do not meet the income eligibility requirements for Medicaid. CHIP may also provide coverage for pregnant women in some states but does not cover adults for children who qualify for CHIP.
Federal law requires states to provide certain “mandatory” benefits and allows states to cover other “optional” benefits in Medicaid and CHIP.
A Dual Special Needs Plan (or Dual-Eligible Health Plan) is a type of health insurance plan for people who have both Medicaid and Medicare. These people are “dual-eligible” because they’re eligible to receive Medicaid benefits as well as Medicare benefits.
Dual Special Needs Plans provide extra help to those who need it. That may be because of income, disabilities, age and/or health conditions.
Dual Special Needs Plans will work together with your Medicaid plan. You’ll keep all your Medicaid benefits. Most dual health plans also give you more benefits and features than you get with Original Medicare.
MANDATORY MEDICAID BENEFITS
Inpatient hospital services
Outpatient hospital services
Early and periodic screening, diagnostic and treatment services (EPSDT)
Nursing facility services
Home health care services
Physician services
Rural health clinic services
Federally qualified health center services
Laboratory and X-ray services
Family planning services
Nursing 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
Speech, hearing, and language disorder services
Respiratory services
Other diagnostic, screening, preventive and rehabilitative services
Podiatry services
Optometry services/eyeglasses
Dental services/dentures
Prosthetics
Chiropractic services
Private duty nursing services
Personal care
Hospice
Case management
Services for individuals aged 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
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