Who qualifies for Medicaid?

Medicaid was passed by the state and federal governments to cover gaps in the healthcare system. This program helps adults, children and families that cannot afford private insurance.

In addition, there are many benefits available through Medicaid that are not available on Medicare. Becoming eligible is the first step to obtain coverage, so let’s start by revealing the most common groups Medicaid provides coverage to.

Medicaid covers low-income families that cannot afford regular health insurance. You qualify by meeting the federal poverty level in your state. The Department of Health and Human Services (HHS) sets new guidelines every year.

Some states have even expanded coverage to every child or adult who falls under a certain poverty level. In other states, however, not every low-income person can qualify for Medicaid. Additional qualifications include age, disability or health status. Many programs require you to meet two or more eligibility requirements.


Children are more likely to receive Medicaid coverage than adults. The parents or guardians enroll their children in managed care plans and then choose doctors from lists. Families receive less expensive and more comprehensive coverage than marketplace insurance.

The types of benefits vary based on the state and the type of medical conditions. In most states, there are plans for disabled children along with children and teens in foster care.

The Children’s Health Insurance Program (CHIP) provides additional coverage to those people that don’t qualify for Medicaid or private insurance. Each state has separate SCHIP programs with income requirements that vary for eligibility.

Disabled citizens

Medicaid serves the low-income and disabled population. Many states have specific programs that cover:

  • Disabled children
  • Deaf and/or legally blind individuals
  • Severely disabled people who cannot work
  • Disabled people who are working

Children with disabilities have access to the most benefits. There are programs that cover those who are institutionalized or disqualify for long-term care. Children who are at risk of developing behavioral and develop-related disabilities are also covered. Another program covers disabled adults who are employed but cannot afford regular insurance.

Pregnant women

Pregnant women are covered under standard benefits: doctor’s visits, hospitalizations and medications. They are also covered for maternity leave and pregnancy-related healthcare services. They may qualify for a special enrollment period that allows them to enroll at a more convenient time.

Elderly citizens with special needs

Medicaid helps the elderly population that needs long-term care at home or in a nursing home. Eligible seniors are covered for the costs of living in nursing homes, hospices and adult day cares. They receive regular benefits for dental check ups, preventative screening, prescription drugs, etc.

Other seniors are covered for in-home services that allow them to live outside of nursing homes. In some states, caregivers are eligible for coverage if they provide care to the elderly, children or the disabled. They may receive benefits only if their care recipient is insured under Medicaid.

The federal government allows every state to participate in the Medicaid program. Most states choose to participate and set their own guidelines and income levels. Low income is the main but not the sole requirement for eligibility. There are other qualifications, such as age and disability, to consider before you choose the right health plan.