What Is Medicaid?
Medicaid is a joint federal and state program that provides free or low-cost health coverage to millions of Americans, including:
People with low incomes
Older adults (65+)
Individuals with disabilities
Pregnant women
Children and families
Each state operates its own Medicaid program with federal oversight, meaning eligibility and benefits can vary by state.
Medicaid Eligibility in 2025
To qualify for Medicaid, you generally must:
Be a U.S. citizen or lawfully present resident
Meet income and resource limits
Belong to a specific eligibility group
Common eligibility categories include:
Individuals aged 65 and older
Low-income adults, including those newly eligible under Medicaid expansion
Children and teens
Pregnant individuals
Individuals who are blind, disabled, or have chronic health conditions
Parents or caretaker relatives of Medicaid-eligible children
SSI and Medicaid Link
In many states, if you qualify for Supplemental Security Income (SSI), you’re automatically eligible for Medicaid. Other states require a separate application and additional income or asset evaluation.
Additionally, some states offer Medicaid buy-in programs for individuals with disabilities who work and earn above traditional limits.
Medicaid Expansion in 2025
Under the Affordable Care Act (ACA), most states have expanded Medicaid to cover more low-income adults. As of 2025, 40+ states and D.C. have adopted Medicaid expansion. This allows childless adults and others without traditional eligibility to access Medicaid coverage based on income alone.
To check your state’s Medicaid status, visit Medicaid.gov.
Dual Eligibility: Medicaid and Medicare
Some individuals qualify for both Medicare and Medicaid. These are known as dual eligibles. In these cases:
Medicare pays first (primary)
Medicaid may cover costs Medicare does not, including:
Part A and B premiums
Deductibles and copays
Long-term care and home health services
If you are dual eligible, you may also qualify for a Medicare Advantage Dual Eligible Special Needs Plan (D-SNP), which combines Medicare and Medicaid benefits into one coordinated plan.
Call MedicareMall at (877) 413-1556 for help exploring D-SNPs and dual eligibility options.
Medicaid-Covered Services
Although each state tailors its Medicaid program, federally mandated benefits typically include:
Doctor visits
Hospital inpatient and outpatient care
Lab and X-ray services
Prescription drugs
Nursing facility and home health care
Pregnancy-related services
Pediatric care and vaccines
Emergency transportation
Behavioral and mental health services
States may also offer optional benefits such as dental, vision, physical therapy, and hospice services.
How to Apply for Medicaid
You can apply for Medicaid:
Online at HealthCare.gov
Through your state Medicaid office
In person or by mail using state forms
You’ll need proof of income, identification, and residency. Some states may request additional documentation for disability or health-related eligibility.