Medicaid is a joint program between federal and state governments that makes sure people with low incomes have healthcare access.
Who Is Eligible for Medicaid?
Medicaid provides health coverage for families and children, pregnant people, the elderly, people with disabilities and some people with low incomes.
In the 39 states (including Washington, D.C.) that agreed to implement the latest expansion of Medicaid, most adults under the age of 65 who have an income lower than 138% of the federal poverty level are eligible. In 2021, that amount is $12,880 for an individual and $21,960 for a family of three.
“If you’re pregnant or have a disability, you can qualify with a higher income,” says Rachel Garfield, vice-president of the Kaiser Family Foundation (KFF) and co-director of its Program on Medicaid and the Uninsured. “Children can qualify if their parents’ income is twice to two-and-a-half times the federal poverty level,” she says.
If you live in one of the 12 states that chose not to expand Medicaid, coverage for nonelderly adults is limited to people who have a child, pregnant women or people who have a disability. “If you’re an adult with no children, you don’t have a disability and you’re not pregnant, you’re not eligible no matter how low your income is,” says Garfield.
What Does Medicaid Cover?
Some benefits must be offered in all plans across all states, according to federal guidelines, including:
- Coverage for hospital stays
- Outpatient hospital services
- Laboratory and X-ray services
- Family planning services
- Nursing facility services
- Home health services
- Doctor visits
- Transportation to medical care
Some of the optional benefits states can choose to offer include:
- Prescription drugs
- Physical therapy
- Occupational therapy
- Speech, hearing and language disorder services
- Respiratory care services
- Optometry services
- Dental services