Medicaid

Medicaid is a joint federal and state program in the United States that funds health coverage for certain low-income individuals and families, as well as some people with disabilities and the elderly. Administered by states within federal guidelines, Medicaid is financed with both federal and state dollars, with the federal share determined by a formula known as FMAP.

Eligibility and scope vary by state and category. The program covers mandatory groups, including low-income children, pregnant women, individuals with disabilities, and elderly people in certain programs. States may also cover optional groups, such as adults without dependent children. Income and asset limits differ by category and state. In many states, the Affordable Care Act expanded eligibility to adults with incomes up to 138% of the federal poverty level, though expansion status varies by state.

Benefits and services provided under Medicaid typically include hospital care, physician services, laboratory and X-ray services, home health care, and nursing facility services. Children’s health services, including comprehensive pediatric care and early and periodic screening, diagnostic, and treatment services, are commonly covered. Long-term services and supports are included in many states for eligible groups, though coverage and cost-sharing can differ.

Enrollment and administration: States administer Medicaid with oversight from the federal Centers for Medicare & Medicaid Services (CMS). People apply through their state Medicaid agency or, in expansion states, via the health insurance marketplace; eligibility is re-determined periodically to maintain coverage. Medicaid plays a central role in reducing uninsured rates and expanding access to care for eligible populations.