Medicaid definition
Medicaid provides free or low‑cost health coverage to eligible low‑income people. It’s run by federal and state governments, with eligibility based largely on income.
Medicaid is a joint federal and state program that provides free or low-cost health coverage to eligible low-income individuals and families. Coverage includes certain children, pregnant people, seniors, and people with disabilities, and states may cover additional groups at their discretion. Eligibility is primarily based on a person’s income and financial resources..
The program covers a comprehensive range of health services: hospital care, doctor visits, preventive care, prescription drugs, mental health services, and long-term care. Each state administers its own Medicaid program within the federal guidelines, so benefits, eligibility, and coverage do vary from state to state, sometimes significantly.
What are the four types of Medicaid?
Most states organize Medicaid coverage around four major eligibility groups:
1. Children: over minors up to age 18 who meet income requirements, generally 138% of the federal poverty level (FPL) under the Affordable Care Act (ACA). This includes “deemed newborns” (infants born to women on Medicaid), certain children in foster care or adoption assistance programs, children with disabilities, and children receiving long-term services.
2. Adults with disabilities: adults with physical disabilities, intellectual or developmental disabilities, serious mental illness, or significant behavioral disorders. Eligibility is tied to both disability status and financial need.
3. Older adults: people 65+ who meet financial eligibility criteria. Many in this group are also Medicare beneficiaries (“dual eligibles”); Medicaid may pay for Medicare premiums or services not covered by Medicare.
4. Nondisabled adults: low-income adults who don’t qualify on the basis of disability or age. Before the ACA, this group was generally limited to pregnant women, low-income parents, and certain caretakers. The ACA gave states the option to expand Medicaid to adults earning to 138% of the FPL and most states have adopted this expansion.
Medicare vs. Medicaid: What's the difference?
