Who Qualifies for Medicaid?
Traditional Medicaid covers specific groups: low-income families, pregnant women, children, people with disabilities, and elderly individuals. The ACA added a new pathway:
| Group | Income Limit (approx.) | Notes |
|---|---|---|
| ACA Medicaid Expansion Adults | Up to 138% FPL (~$20,120 single / $34,307 family of 3 in 2024) | Available in 40 expansion states + DC |
| Children (Medicaid) | Up to 133% FPL (some states higher) | CHIP covers children in higher-income families |
| Pregnant women | 133%–200%+ FPL (varies by state) | Coverage continues 12 months postpartum |
| People with disabilities | Varies; asset tests apply in many states | Often linked to SSI eligibility |
| Elderly (65+) with low income | Varies by state | May receive both Medicare and Medicaid (dual eligible) |
Medicaid vs. Medicare
| Feature | Medicaid | Medicare |
|---|---|---|
| Primary basis | Need (income/assets) | Age (65+) or disability |
| Who pays | Federal + state governments | Federal government |
| Cost to enrollee | Free or minimal copays | Premiums, deductibles, coinsurance |
| Covers long-term care? | ✅ Yes (nursing home, home care) | ❌ Limited (only short-term skilled nursing) |
| Dental/vision/hearing | Often covered (varies by state) | ❌ Not covered in Original Medicare |
| Run by | State agencies | Federal (CMS) |
CHIP: Children's Health Insurance Program
CHIP covers children in families who earn too much for Medicaid but can't afford private insurance. Key facts:
- Covers children up to age 19
- Income limits typically 200%–300%+ FPL (varies dramatically by state; some states up to 400%)
- Low or no premiums, minimal copays
- Comprehensive coverage: doctor visits, dental, vision, hospital care, prescriptions
- Some states offer CHIP for pregnant women
How to Apply
Apply through your state's Medicaid agency or HealthCare.gov. You can apply any time—Medicaid has no open enrollment period. If your income drops due to job loss, you can enroll immediately. Applications are often processed within 45 days (90 days for disability-based cases).
If you live in a non-expansion state (TX, FL, GA, etc.) and earn below 100% FPL, you may fall into the "coverage gap"—too much income for traditional Medicaid but not enough for Marketplace subsidies (which start at 100% FPL). Check your state's specific rules at Medicaid.gov.