Medicaid 101
Most people have heard of Medicaid, the government health care program for families, children and seniors. But what is it, really?
Medicaid is, in simple terms, a program that pays the medical costs of individuals in groups with limited incomes. In slightly less simple terms, Medicaid is a program run by the federal government and individual states to provide coverage for health care, from primary care to inpatient hospital services and nursing facilities care, for people who are at or below a certain income level.
Groups that can utilize Medicaid services include:
- Low-income children and their families
- Low-income seniors (65+ years old)
- Low-income individuals with disabilities
Eligibility Requirements
You may be wondering how much is considered 'low income'. The federal minimum income for children and pregnant people to qualify for Medicaid is currently 133% of the federal poverty level (FPL), or approximately $35,630 per year for a family of three (the 2024 FPL is $25,820). Please refer to your state of residence for further eligibility requirements, as state requirements vary.
For low-income seniors and those with disabilities, there is substantial state variation in eligibility, and there is no Modified Adjusted Gross Income (MAGI) pathway for seniors or individuals with disabilities, so qualifying is more complicated.
Click the following state names to learn more about eligibility in select states.
Applying for Medicaid
Individuals must apply for Medicaid through their state's website; this means creating an account and providing certain documents and information. While this varies by state, it may include:
- Name and date of birth
- Social Security number
- Monthly payments for rent, mortgage and/or utilities
- Proof of citizenship or immigration status
- Proof of income, such as paystubs or your W2
- Verification of other government benefits (if you receive any)
- Insurance information, either through an employer or independently
Medicaid vs CHIP
Another program for families is the Children's Health Insurance Program (CHIP). Your child(ren) may qualify for CHIP if your income is too high for Medicaid. CHIP covers dental and medical care for uninsured children up to 19 years old.
In most states, children in families with income up to $80,000 per year for a family of four (please note that this varies from state to state). Eligibility information for CHIP is available on your state's website.
Sources:
InsureKids.Gov: Frequently Asked Questions
