What Is Medicaid and Who Qualifies?

Medicaid provides free or low-cost health coverage to millions of Americans — but eligibility rules vary by state. Here's a plain-language guide to understanding and applying.

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Medicaid is a joint federal-state program that provides free or very low-cost health coverage to eligible low-income individuals and families. Here's how it works.

Who Qualifies for Medicaid?
Eligibility depends on income, household size, state of residence, and other factors. Generally:
- Adults with income up to 138% of the Federal Poverty Level (in states that expanded Medicaid)
- Children (CHIP covers children in many states at higher income levels)
- Pregnant women
- Seniors and people with disabilities (in coordination with Medicare)

Medicaid Expansion
Under the ACA, states could choose to expand Medicaid to cover all adults up to 138% FPL. Most states (including Illinois, Maryland, Michigan, North Carolina, Ohio, Pennsylvania, Tennessee, Virginia, and New York) have expanded. Texas and some others have not.

What Does Medicaid Cover?
Medicaid covers a comprehensive set of benefits including doctor visits, hospital care, prescriptions, mental health services, long-term care, and more — often with little or no cost-sharing.

Medicaid vs. ACA Marketplace
If you qualify for Medicaid, you're not eligible for Premium Tax Credits on the ACA marketplace. If your income is between 100–138% FPL and your state hasn't expanded Medicaid, you may fall into the "coverage gap" — an ongoing policy issue.

How to Apply
You can apply through your state's Medicaid agency, healthcare.gov, or through a certified enrollment specialist like Chime Insurance Group.

*Unsure if you qualify? Our advisors can assess your eligibility for Medicaid, CHIP, or ACA marketplace coverage at no cost.*