What Is Medicaid?
Medicaid is a joint federal and state health insurance program that provides coverage to eligible:
Low-income adults and families
Seniors (65+)
Individuals with disabilities
Pregnant women
Children
Each state administers its own Medicaid program, which means eligibility rules, cost-sharing, and covered services can vary from one state to another. However, all programs must meet certain federal guidelines.
To qualify, you must generally be a U.S. citizen or lawful permanent resident residing in the state where you’re applying.
Medicaid Eligibility Requirements (2025)
While states have flexibility in how they structure their programs, there are common eligibility groups that generally qualify:
Key Medicaid Eligibility Categories:
Low-income adults (typically under 138% of the Federal Poverty Level in expansion states)
Children
Pregnant individuals
Seniors (65+)
People who are blind or disabled
Caretaker relatives of Medicaid-eligible children
SSI and Medicaid
In many states, qualifying for Supplemental Security Income (SSI) automatically qualifies you for Medicaid. In others, additional financial criteria may apply, and the state may evaluate both income and resources (excluding your home and primary vehicle in most cases).
Medicaid Expansion and the ACA
Under the Affordable Care Act, most states expanded Medicaid eligibility to low-income adults who were previously ineligible, including childless adults. As of 2025:
40+ states and Washington D.C. have adopted Medicaid expansion
Non-expansion states still apply stricter eligibility criteria
To see your state’s status, visit Medicaid.gov’s State Profiles.
Medicaid Cost Sharing – What You Might Pay
Medicaid is designed to be low-cost or free. However, some states may impose small:
Copayments for services like doctor visits or prescription drugs
Premiums for certain Medicaid programs (e.g., Medicaid Buy-In for workers with disabilities)
Cost-sharing adjustments based on income
Even in states that allow cost sharing, Medicaid must remain affordable for all enrollees.
Dual Eligibility: Medicare + Medicaid
Some individuals qualify for both Medicare and Medicaid—known as dual eligibles. In these cases:
Medicare pays first for covered services
Medicaid may pay remaining costs such as copayments, coinsurance, and premiums
You may qualify for a Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) that coordinates both benefits
Call MedicareMall at (877) 413-1556 to explore D-SNP options and find out if dual coverage is right for you.
How to Learn More About Medicaid in Your State
To find out about your state’s Medicaid eligibility rules, cost-sharing requirements, and application process:
Visit Medicaid.gov
Use the “State Profiles” feature to access your state’s dedicated Medicaid page
Or contact your local state Medicaid office
Need Help Navigating Your Options?
If you’re unsure whether you qualify for Medicaid or how to coordinate it with Medicare, MedicareMall is here to help. Our licensed and bonded team can:
Help determine your Medicaid eligibility
Explain dual eligibility rules
Recommend Medicare Advantage or Medigap plans to fit your needs
Guide you through the application process
Call (877) 413-1556
Or Request a Free Consultation