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What is Medicaid? A plain-English guide to how it works

The short answer

Medicaid is public health coverage for people with low incomes. Each state runs its own program under federal rules, and states and the federal government share the cost. It covers children, pregnant women, parents, older adults, people with disabilities and, in most states, other low-income adults. It is free or very low cost for people who qualify.

By Last reviewed Sources

Constantino Lardi, FreedInsure's licensed agent, is licensed in 42 jurisdictions. He owns FreedInsure, the private agency that publishes this guide, and insurers may pay FreedInsure when people enroll with its help.

Apply for free on your state's official site

Medicaid and CHIP applications are free, and you can apply any time of year. Apply directly with your state Medicaid agency, or through HealthCare.gov if your state uses it.

Apply through HealthCare.gov

All states: Medicaid agency websites

State agency links from Medicaid.gov's directory of state Medicaid agencies, checked October 19, 2026.

Medicaid in plain English

Medicaid is a health coverage program for people with low incomes. Federal law sets the basic rules. Each state runs its own program and decides many of the details. The state and federal governments share the cost (Medicaid.gov).

It is a big program. In June 2026, 65,969,381 people were enrolled in Medicaid. Counting CHIP, the total was 73,167,389 (Medicaid.gov enrollment report).

Many states give their program its own name. In California it is Medi-Cal. In Massachusetts it is MassHealth. In Tennessee it is TennCare. If a letter or card uses a name you don't know, check the state table below.

Medicaid is not Medicare

Medicare is federal health insurance for people 65 or older. Some younger people get it too, because of a disability, kidney failure or ALS (Medicare.gov). Medicaid is based mainly on income and need. Some people have both. They are called "dually eligible" (Medicare.gov). Our guide to how Medicaid and Medicare differ goes deeper.

Where CHIP fits

CHIP is the Children's Health Insurance Program. It covers children in families that earn too much for Medicaid. In some states it also covers pregnant women. Routine checkups and dental visits for children are free under CHIP. A family won't pay more than 5% of its yearly income (HealthCare.gov). You can find your state's CHIP at InsureKidsNow.gov.

Who Medicaid covers

Federal law says every state must cover some groups. These include certain low-income families, pregnant women and children who qualify, and people who get Supplemental Security Income (SSI) (Medicaid.gov). In practice, Medicaid covers:

  • Children and teens.
  • Pregnant women.
  • Parents and other caretakers with low incomes.
  • Older adults and people with disabilities who meet the rules.
  • Other adults ages 19 to 64, in states that expanded Medicaid.

The adult expansion

The Affordable Care Act (ACA) let states cover adults ages 19 to 64 based on income alone. The rule is income at or below 133% of the federal poverty level (FPL) (42 CFR 435.119, law.cornell.edu). The FPL is a yearly income amount the government sets for each household size. States also subtract 5 points of FPL from your income, so the limit works out to 138% (42 CFR 435.603, law.cornell.edu).

A quick example: the 2026 poverty guideline for one person is $15,960 in the 48 contiguous states and DC (aspe.hhs.gov). So 138% is about $22,025 a year, or about $1,835 a month. Alaska and Hawaii use higher guidelines.

As of October 16, 2026, 41 states (counting DC) had expanded Medicaid and 10 had not (KFF.org). In states that have not, many adults with very low incomes can't get Medicaid. Their income can also be too low for Marketplace savings. This is often called the coverage gap (HealthCare.gov).

Limits are different in each state and for each group. For state-by-state numbers, see FreedInsure's Medicaid income limits by state. FreedInsure is the private insurance agency that publishes this guide.

Other rules

  • Where you live. You generally must live in the state where you get Medicaid (Medicaid.gov).
  • Citizenship or immigration status. You must be a U.S. citizen or have an eligible immigration status, such as a green card (Medicaid.gov). Many immigrants must also wait 5 years after getting that status. States can drop the wait for children and pregnant women who are lawfully residing in the U.S. (HealthCare.gov).
  • New limits since October 1, 2026. Federal Medicaid money can now be used only for U.S. citizens and nationals, green card holders, Cuban and Haitian entrants, and people who live here under a Compact of Free Association (from Micronesia, the Marshall Islands or Palau). There are two exceptions. One is emergency care. The other is the state option for lawfully residing children and pregnant women (Public Law 119-21, sec. 71109, govinfo.gov). Ask your state how this affects you.
  • Only your state decides. No website or agent can tell you for sure. If you're not sure, apply. It costs nothing to apply.

What Medicaid pays for, and what you pay

Every state must cover a core set of services. The list includes hospital care, doctor visits, lab tests and X-rays, home health care, nursing home care, family planning, care at community health centers and rides to medical care. It also includes a checkup, screening and treatment benefit for children called EPSDT (Medicaid.gov).

EPSDT covers children and teens under 21. It includes dental care, eye care and hearing care (Medicaid.gov).

States can add optional benefits too. Examples include prescription drugs, adult dental care, eyeglasses and physical therapy. Drugs are optional under federal law, but every state covers them today (Medicaid.gov). Other benefits differ by state, so check your state's member handbook.

Medicaid and CHIP are free or very low cost for people who qualify. Rules depend on your state, income and household size. Here is what federal rules say about costs (Medicaid.gov):

  • Copays for most services are kept small. If your income is above the poverty level, your state can charge more for some care.
  • All premiums and copays for your family can't add up to more than 5% of its income (42 CFR 447.56, law.cornell.edu).
  • Children and pregnant women don't pay most out-of-pocket costs.
  • Emergency care, family planning, pregnancy care and preventive care for children have no copays or other out-of-pocket charges.
  • States can charge limited premiums to some groups with income above 150% FPL (Medicaid.gov). A premium is a regular fee you pay to keep your coverage.

Looking ahead: starting October 1, 2028, states must charge some copays to expansion adults with income above the poverty level. Each copay is capped at $35. Primary care, mental health care and visits to community health centers stay copay-free (Public Law 119-21, sec. 71120, govinfo.gov).

Medicaid in 2027: what's changing

Checked October 19, 2026. A 2025 federal law, Public Law 119-21 (also called the One Big Beautiful Bill Act), brings these three changes in 2027 (govinfo.gov). The first two apply to adults in the expansion group. States are still setting them up. Watch your mail and your state's website.

  • Renewals every 6 months for expansion adults. For renewals scheduled on or after January 1, 2027, states must check most adults in the expansion group every 6 months. Certain American Indians and Alaska Natives are exempt. People in other Medicaid groups, such as children, pregnant women and people with disabilities, stay on yearly renewals (CMS letter SMD 26-001, Medicaid.gov). See how Medicaid renewal works.
  • Work requirements. By January 1, 2027, states must require most expansion adults ages 19 to 64 to meet a work rule. Each month, they must work, volunteer or be in a work program for 80 hours in all, or go to school at least half-time. Earning at least $580 a month (the 2026 figure) also counts. Parents of children 13 and under and people who are medically frail are among those exempt (CMS.gov). A state can get more time, but not past December 31, 2028. If you are denied or lose Medicaid because you didn't meet this rule, you also can't get the premium tax credit (PTC). The PTC is a tax credit that lowers the monthly cost of a Marketplace plan (sec. 71119, govinfo.gov). For state details, see FreedInsure's guide to 2027 work requirements. FreedInsure is the private insurance agency that publishes this guide.
  • Less coverage for past bills. Today, Medicaid can pay for covered care you got up to 3 months before the month you applied. You must have qualified at the time (42 CFR 435.915, law.cornell.edu). For applications made on or after January 1, 2027, that drops to 1 month for expansion adults and 2 months for everyone else (sec. 71112, govinfo.gov).

Getting Medicaid: where your application goes

You can apply for Medicaid any time of year. There is no enrollment season (HealthCare.gov).

  1. Apply with your state. Use your state's official site from the table below. Each state's site lists the ways to apply, such as online, by phone, by mail or in person.
  2. Or apply through the Marketplace. One application checks you for Medicaid, CHIP and Marketplace savings. If you look eligible for Medicaid, the Marketplace sends your information to your state, and the state contacts you. In a HealthCare.gov state, you can also apply by phone at 1-800-318-2596 (HealthCare.gov).
  3. Watch your mail. The state may ask for proof. Send it by the date on the letter. In most cases, the state must decide within 45 days. If you apply based on a disability, the limit is 90 days (42 CFR 435.912, law.cornell.edu).
  4. Tell them about recent bills. If you got care in the months before you applied, say so. Some of it may be covered (see the 2027 change above).
  5. If you're approved, read the notice. Many states deliver Medicaid through private health plans that contract with the state. This is called managed care (Medicaid.gov). If your state uses it, you may be asked to pick a plan. Keep your member card and the plan's phone number.

Have these ready

  • Name, birth date and home address for each person who is applying.
  • Social Security numbers for people who have one.
  • Immigration document details for anyone applying who is a lawfully present immigrant.
  • Income for everyone in your household, such as pay stubs, W-2 forms or benefit letters.
  • How you file taxes and who you claim as a dependent.
  • Insurance cards or policy numbers for any coverage you have now. Also, details of any job-based plan you could join.

Based on the HealthCare.gov get ready to apply checklist. Your state may ask for other papers.

What to say when you call your state

"Hi, I'd like to apply for Medicaid for myself and my family. Can I apply over the phone today? What proof will you need from me? I also had medical bills in the last few months. Can I ask for those to be covered too?"

Medicaid names and application sites, state by state

This table gives the name each state uses and the state's own page on how to apply. We opened every link on October 19, 2026.

Medicaid program names and where to apply, by state (checked October 19, 2026)
State What the state calls it State site with how to apply
Alabama Alabama Medicaid medicaid.alabama.gov
Alaska Alaska Medicaid health.alaska.gov
Arizona AHCCCS azahcccs.gov
Arkansas Arkansas Medicaid, including ARHOME and ARKids First access.arkansas.gov
California Medi-Cal dhcs.ca.gov
Colorado Health First Colorado healthfirstcolorado.gov
Connecticut HUSKY Health portal.ct.gov
Delaware Delaware Medicaid (Diamond State Health Plan) assist.dhss.delaware.gov
District of Columbia DC Medicaid dhcf.dc.gov
Florida Florida Medicaid myflfamilies.com
Georgia Georgia Medicaid medicaid.georgia.gov
Hawaii Med-QUEST medquest.hawaii.gov
Idaho Idaho Medicaid healthandwelfare.idaho.gov
Illinois Illinois Medicaid hfs.illinois.gov
Indiana Indiana Medicaid, including the Healthy Indiana Plan and Hoosier Healthwise in.gov
Iowa Iowa Medicaid, including the Iowa Health and Wellness Plan hhs.iowa.gov
Kansas KanCare kancare.ks.gov
Kentucky Kentucky Medicaid chfs.ky.gov
Louisiana Louisiana Medicaid (Healthy Louisiana plans) ldh.la.gov
Maine MaineCare maine.gov
Maryland Maryland Medicaid (HealthChoice plans) marylandhealthconnection.gov
Massachusetts MassHealth mass.gov
Michigan Michigan Medicaid, including the Healthy Michigan Plan michigan.gov
Minnesota Medical Assistance mn.gov
Mississippi Mississippi Medicaid medicaid.ms.gov
Missouri MO HealthNet dss.mo.gov
Montana Montana Medicaid dphhs.mt.gov
Nebraska Nebraska Medicaid (Heritage Health plans) dhhs.ne.gov
Nevada Nevada Medicaid dss.nv.gov
New Hampshire NH Medicaid, including Granite Advantage dhhs.nh.gov
New Jersey NJ FamilyCare njfamilycare.dhs.state.nj.us
New Mexico New Mexico Medicaid (Turquoise Care plans) hca.nm.gov
New York New York Medicaid health.ny.gov
North Carolina NC Medicaid medicaid.ncdhhs.gov
North Dakota North Dakota Medicaid hhs.nd.gov
Ohio Ohio Medicaid benefits.ohio.gov
Oklahoma SoonerCare oklahoma.gov
Oregon Oregon Health Plan (OHP) oregon.gov
Pennsylvania Medical Assistance (Pennsylvania Medicaid) pa.gov
Rhode Island Rhode Island Medicaid, including RIte Care eohhs.ri.gov
South Carolina Healthy Connections Medicaid scdhhs.gov
South Dakota South Dakota Medicaid dss.sd.gov
Tennessee TennCare tn.gov
Texas Texas Medicaid yourtexasbenefits.com
Utah Utah Medicaid medicaid.utah.gov
Vermont Vermont Medicaid, including Dr. Dynasaur dvha.vermont.gov
Virginia Cardinal Care coverva.dmas.virginia.gov
Washington Apple Health hca.wa.gov
West Virginia West Virginia Medicaid bms.wv.gov
Wisconsin BadgerCare Plus and other Wisconsin Medicaid programs dhs.wisconsin.gov
Wyoming Wyoming Medicaid health.wyo.gov

Source: Each state's own Medicaid site (linked in each row, opened 2026-10-19), cross-checked against Medicaid.gov's directory of state Medicaid and CHIP agencies. Verified October 19, 2026.

Table compiled by FreeHealthInsurance.com (FreedInsure LLC); free to reuse under CC BY 4.0 with credit.

What the table tells you: in 18 states, the main name doesn't use the word "Medicaid." Examples are SoonerCare, Apple Health and MaineCare. If you see one of these names on a letter or card, it is Medicaid. Some states, like Maryland, take applications through their health insurance marketplace. Others use one site for Medicaid, food help and cash help.

Applying is free in every state. Be careful with anyone who asks you for money to sign you up. Wyoming's Medicaid site, for one, warns that its programs never charge or ask for money to enroll or re-enroll. To be safe, start from the web address in this table.

If you're denied, or Medicaid isn't a fit

Read the notice the state sends. It should say why. If you think it's wrong, you can ask for a fair hearing. Your state must give you a fair amount of time to ask. It can't be more than 90 days from the date the notice was mailed (42 CFR 431.221, law.cornell.edu). Your deadline may be shorter, so check the notice right away. If your income or family changes later, you can apply again.

Already on Medicaid and got a notice that it will end or be cut? Ask for a hearing before the date the change takes effect. In most cases, your coverage then stays in place until the hearing decision. If you lose the hearing, the state may ask you to repay the cost of care you got while you waited (42 CFR 431.230, law.cornell.edu).

Your other options, cheapest first

Community health centers

Who qualifies
Anyone, with or without insurance. A health center that gets federal health center grants can't deny you care because you can't pay (42 CFR 51c.303, law.cornell.edu).
What it costs
Community health centers charge on a sliding scale based on income; some visits cost little or nothing.
How to get it
Find one in our guide to community health centers.

Hospital financial assistance

Who qualifies
Patients who meet a hospital's own rules. Each nonprofit hospital must have a written financial assistance policy (IRS.gov).
What it costs
Free or discounted care, depending on the hospital's policy and your income.
How to get it
Ask the hospital for its application. Our guide to hospital charity care walks you through it.

A Marketplace plan

Who qualifies
People who don't qualify for Medicaid. Income between 100% and 400% FPL can qualify for the premium tax credit (HealthCare.gov). People turned down or dropped from Medicaid over the work rule can't get the credit.
What it costs
A monthly premium, plus a deductible and copays. The deductible is what you pay for care before the plan starts to pay. The tax credit lowers the premium if you qualify.
How to get it
Apply at HealthCare.gov or your state's official marketplace. You can sign up during the yearly Open Enrollment period, or after a life change such as losing Medicaid (HealthCare.gov). Check HealthCare.gov or your state's marketplace for your dates.

No insurance right now? Our guide to getting care without insurance lists more low-cost routes.

Find it near you (official and nonprofit finders)

Common questions

Is Medicaid the same as Medicare?
No. Medicare is federal health insurance for people 65 or older and some younger people with a disability or kidney failure. Medicaid is run by each state for people with low incomes. Some people have both. See Medicaid vs. Medicare.
Is Medicaid free?
Medicaid and CHIP are free or very low cost for people who qualify. Rules depend on your state, income and household size. Copays for most services are kept small, and all premiums and copays for a family can't add up to more than 5% of its income. Emergency care has no out-of-pocket charges.
Can I apply for Medicaid at any time of year?
Yes. Medicaid has no sign-up season. You can apply any time through your state or through the Marketplace, and applying costs nothing.
Will Medicaid pay for medical bills I already have?
It may. Today, Medicaid can cover care from up to 3 months before the month you apply, if you would have qualified then. For applications made on or after January 1, 2027, the limit is 1 month for expansion adults and 2 months for everyone else. Tell your state about recent bills when you apply.
How often do I have to renew Medicaid?
Most people renew once a year. For renewals scheduled on or after January 1, 2027, most adults in the expansion group renew every 6 months. Keep your address up to date so you get the renewal letter. Read more about Medicaid renewal.

To apply for Medicaid or CHIP, use your state's official application or HealthCare.gov. Applying is free. FreedInsure can't enroll you in Medicaid or CHIP.

Sources

  1. Medicaid.gov, Medicaid (program overview), accessed October 19, 2026
  2. Medicaid.gov, Eligibility Policy, accessed October 19, 2026
  3. Medicaid.gov, Mandatory & Optional Medicaid Benefits, accessed October 19, 2026
  4. Medicaid.gov, Cost Sharing, accessed October 19, 2026
  5. Medicaid.gov, Cost Sharing Out of Pocket Costs (nominal amounts and exempt services), accessed October 19, 2026
  6. 42 CFR 447.56, Limitations on premiums and cost sharing (exemptions; 5 percent aggregate limit) (law.cornell.edu), accessed October 19, 2026
  7. Medicaid.gov, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), accessed October 19, 2026
  8. Medicaid.gov, Prescription Drugs (optional benefit covered by all states), accessed October 19, 2026
  9. Medicaid.gov, Managed Care, accessed October 19, 2026
  10. Medicaid.gov, Medicaid and CHIP Enrollment Data: Report Highlights (June 2026, updated Sept 25, 2026), accessed October 19, 2026
  11. Public Law 119-21 (H.R. 1, July 4, 2025), secs. 71107, 71109, 71112, 71119 and 71120 (GPO) (govinfo.gov), accessed October 19, 2026
  12. CMS, State Medicaid Director Letter SMD #26-001, six-month renewals (March 6, 2026) (medicaid.gov), accessed October 19, 2026
  13. CMS, Fact sheet: Medicaid community engagement requirement interim final rule (June 1, 2026) (cms.gov), accessed October 19, 2026
  14. 42 CFR 435.119, Coverage for individuals age 19 or older and under age 65 at or below 133 percent FPL (law.cornell.edu), accessed October 19, 2026
  15. 42 CFR 435.603(d)(4), 5 percentage point income disregard (law.cornell.edu), accessed October 19, 2026
  16. 42 CFR 435.912, Timeliness standards (45 and 90 days) (law.cornell.edu), accessed October 19, 2026
  17. 42 CFR 435.915, Effective date (three months of retroactive eligibility) (law.cornell.edu), accessed October 19, 2026
  18. 42 CFR 431.221, Request for hearing (up to 90 days) (law.cornell.edu), accessed October 19, 2026
  19. 42 CFR 431.230, Maintaining services while a hearing is pending (law.cornell.edu), accessed October 19, 2026
  20. 42 CFR 51c.303, Health center sliding fee and no denial for inability to pay (law.cornell.edu), accessed October 19, 2026
  21. HHS ASPE, 2026 Poverty Guidelines (aspe.hhs.gov), accessed October 19, 2026
  22. HealthCare.gov, Getting Medicaid & CHIP, accessed October 19, 2026
  23. HealthCare.gov, Medicaid expansion & what it means for you, accessed October 19, 2026
  24. HealthCare.gov, Children's Health Insurance Program (CHIP), accessed October 19, 2026
  25. HealthCare.gov, Coverage for lawfully present immigrants (5-year wait for Medicaid and CHIP), accessed October 19, 2026
  26. HealthCare.gov, Dates and deadlines (Open Enrollment and Special Enrollment Periods), accessed October 19, 2026
  27. HealthCare.gov, Get ready to apply for or re-enroll in Marketplace coverage (checklist PDF), accessed October 19, 2026
  28. Medicare.gov, Get started with Medicare, accessed October 19, 2026
  29. Medicare.gov, Medicaid (dual eligibility), accessed October 19, 2026
  30. IRS, Financial assistance policies (FAPs) (irs.gov), accessed October 19, 2026
  31. KFF, Status of State Medicaid Expansion Decisions (published Oct 16, 2026; data only) (kff.org), accessed October 19, 2026
  32. Wyoming Department of Health, Apply for Medicaid or Kid Care CHIP (scam warning) (health.wyo.gov), accessed October 19, 2026
  33. Each state's own Medicaid site (linked in each row, opened 2026-10-19), cross-checked against Medicaid.gov's directory of state Medicaid and CHIP agencies, accessed October 19, 2026