How Medicaid works

In general, Medicaid helps pay for healthcare services like doctors’ visits and hospital care. Each state runs its own Medicaid program, following basic rules set by the federal government.

Because each state Medicaid program is different, the rules and benefits can be different depending on where you live. The name of the Medicaid program may also be different depending on where you live. For example:

  • California’s Medicaid program is called Medi-Cal. 
  • Kansas’s Medicaid program is called KanCare.
  • South Carolina’s Medicaid program is called Healthy Connections.

Find your state’s Medicaid program

Your state Medicaid office is the most reliable place to find the rules that apply to you and the services available where you live. When you click the link below, find the map and click on your state. It will give your state office contact information and provide you with information on your state’s eligibility and explain how to enroll.

Find your state Medicaid agency

Am I eligible for Medicaid?

To qualify for Medicaid, you must meet two requirements.

senior woman talking to nurse aide

Income

Your household income must be below your state Medicaid program’s income threshold. The limit also depends on how many people are in your family.

Check your state’s eligibility

Household

One of these must apply to you or someone in your home:

  • A child or teenager
  • Pregnant
  • A parent or caregiver of a child
  • An adult with income under your state’s threshold
  • Age 65 or older
  • A person with a disability

What does Medicaid pay for?

The federal government requires all states to cover certain healthcare costs as part of their Medicaid program. States can also choose to cover additional costs as part of their program. This means the costs covered by Medicaid can vary by state.

In general, Medicaid may cover:

  • Doctor visits and checkups
  • Hospital care
  • Prescription medicines
  • Lab tests and X-rays
  • Mental health and substance use treatment
  • Pregnancy and newborn care
  • Nursing home and other long-term care
  • Preventive care, such as vaccines and screenings

Applying for Medicaid

If you think you may qualify for Medicaid, you can apply at any time during the year. Depending on your state, you may be able to apply online, by phone, in person, or by mail. Check with your state Medicaid office to find out how to apply and what information you need.

Find your state Medicaid agency
senior couple looking at paperwork

What happens after I apply?

Your state will review your application and send you a notice with its decision. You should hear back within 45 days. If your Medicaid eligibility depends on a disability determination, it can take up to 90 days because it involves reviewing medical records and other documentation. If you are approved, the notice will explain when your coverage starts and what you need to do next.

If your application is denied, you generally have the right to appeal the decision. Follow the instructions and deadline in your notice.

woman checking in at clinic desk

Do I need to renew Medicaid?

Yes. Your state will review your eligibility regularly. 

It’s important to note that people in the same household who are on Medicaid may have different renewal dates. Watch for notices from your state Medicaid office and respond by the deadline to help keep your coverage.

How is Medicaid different from Medicare? 

Medicaid and Medicare are both government health insurance programs, but they are for different groups of people and work differently.

Medicaid is generally for people who meet their state requirements, which can include rules related to income, age, pregnancy, disability, or family situation. Each state runs its own Medicaid program.

Medicare is generally for people age 65 and older and some younger people with disabilities or certain medical conditions. The federal government runs Medicare.

Learn more about Medicare

Read our guides to Medicare, including open enrollment, the Part D cap, Prescription Payment Plan, and Extra Help.

Learn more

Can I have both Medicaid and Medicare?

Yes. Some people can get both Medicaid and Medicare. They are sometimes called dual eligible.

When someone has both, Medicare generally pays your medical bills first. Medicaid may help pay some costs that Medicare does not cover, depending on your situation and state rules.

If you have both, check with your state Medicaid program or Medicare to understand how the two programs work together.