In Triage Cancer's free Quick Guide to Medicaid, learn about what Medicaid is called in different states , how to qualify , how Medicaid and Medicare can work together , how and when to apply for Medicaid , what Medicaid covers , what it costs , appealing denials of coverage , and moving and Medicaid .
Medicaid is a federal program that provides free or low-cost health insurance coverage to certain individuals. Medicaid is the largest source of health coverage in the country, covering more than 88 million people.
Even though Medicaid is a federal program, it is run at the state level. Medicaid is funded at the federal and state level. The federal government requires all states to provide a minimum level of benefits, but states are allowed to apply for exceptions. So, while Medicaid programs must follow federal rules, the coverage, costs, and other details may be different in each state. For example, Medicaid programs have different names. For a full list of specific Medicaid state names and laws, visit our resource, Medicaid State Laws: Coverage and Navigation .
In all states, Medicaid is available to people with a low income, low resources, and meet a specific category of eligibility. Those categories are different in each state, but usually include:
Resources are things like money in a bank account or retirement account, like a 401k plan.
These different categories of eligibility are like different doors into the Medicaid program. Some doors require that you have a low income and resource level, while the Medicaid expansion door only requires that you have a low income.
States may have different rules on what income level you must have to get in certain doors. For example, if you have a disability, you may need to have an income level below 100% of the federal poverty level (FPL). If you are a child, your family income may need to be below 250% of the FPL.
States may also have their own special doors to get into the Medicaid program. For example, Minnesota and New York also give individuals with a household income between 138-200% FPL access to Medicaid through the Basic Health Program.
Since 2014, 41 states have expanded Medicaid to people with a household income under 138% of the federal poverty level ($21,597 in 2025), creating a new door into Medicaid. In these states, Medicaid will only look at your income to see if you qualify for this program, not your resources. This is called Medicaid expansion.
See the chart below or visit TriageCancer.org/Medicaid-Expansion to see if your state has expanded Medicaid.
| Household Size | 138%* |
|---|---|
| 1 | $21,597 |
| 2 | $29,187 |
| 3 | $36,777 |
| 4 | $44,367 |
| 5 | $51,957 |
| 6 | $59,547 |
*In 2024. Amounts higher for Hawaii & Alaska.
| Expanded: 41 | Not Expanded: 10 |
|---|---|
| AK, AR, AZ, CA, CO, CT, DC, DE, HI, IA, ID, IL, IN, KY, LA, MA, MD, ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SD, UT, VA, VT, WA, WV | AL, FL, GA, KS, MS, SC, TN, TX, WI, WY |
If you are over the age of 65, or if you are receiving Social Security Disability Insurance (or SSDI) benefits, then you may also be eligible for Medicare. Medicare is another federal health insurance program for seniors and people with disabilities. If you qualify for both programs, Medicare typically is the primary payer. Medicaid can help pay for things Medicare doesn’t pay for (e.g., dental care in some states), and lowers out-of-pocket costs for Medicare Parts A and B. States can also pay premiums for Medicare Advantage (MA) plans.
You can apply for Medicaid at any time. You can apply online at HealthCare.gov , or through your state Medicaid agency .
Your Medicaid coverage will start usually start on the day that you apply, or on the first day of the month that you apply. Some states will also go back three months before you applied, to pay for any medical care that you received. If you stop being eligible for Medicaid, your coverage will usually end at the end of that month.
There are two types of Medicaid plans: fee-for-service plans and managed care plans.
Depending on the state and county that you live in, you may have access to fee-for-service plans, managed care plans, or both.
In every state, Medicaid covers medical care that you receive in a hospital, or outside of a hospital, like going to visit your doctor. It also covers things like blood tests, x-rays, and scans. It covers care when you are pregnant, as well as mental health care. Medicaid also pays for long-term care services. Medicaid must also cover routine costs when you participate in a clinical trial.
*This includes services furnished in a religious nonmedical health care institution, emergency hospital services by a non-Medicare certified hospital, and critical access hospital (CAH).
What you pay each month for Medicaid depends on the state that you live in and how you qualify for Medicaid. You may also have to pay certain costs out-of-pocket. For example, a co-payment is a fixed dollar amount that you have to pay when you get certain types of medical care. So, if you need a prescription drug, you may have to pay a co-payment at the pharmacy.
If you receive a claim denial or a denial of Medicaid eligibility, you have the right to appeal. The details of the appeals process may depend on where you live and whether you have fee-for-service Medicaid or a Medicaid managed care plan, but generally, you must file an appeal within 90 days of receiving the Notice of Action (NOA). If you file within 10 days, you may continue to receive benefits while your appeal is pending. You should contact the Medicaid Office where you live (or where you lived when you received the services). If you need help with a Medicaid appeal, you can contact a local legal aid organization that handles Medicaid or government benefits cases.
Because each state operates its own Medicaid program and has different rules, you cannot transfer your Medicaid coverage from one state to another, and you cannot have Medicaid coverage in two states at the same time. But if you are moving to a new state, it is important to:
Contact your state Medicaid agency for help with:
To find the contact information for your state’s Medicaid agency visit TriageCancer.org/StateResources .
For more information about Medicaid and other health insurance options,
visit TriageCancer.org/HealthInsurance
or CancerFinances.org
.
Last updated: 01/2025
Disclaimer: This handout is intended to provide general information on the topics presented. It is provided with the understanding that Triage Cancer is not engaged in rendering any legal, medical, or professional services by its publication or distribution. Although this content was reviewed by a professional, it should not be used as a substitute for professional services. © Triage Cancer 2025
We're glad you find this resource helpful! Please feel free to share it with your communities or to post a link on your organization's website. However, this content may not be reproduced, in whole or in part, without the express permission of Triage Cancer. Please email us at info@TriageCancer.org to request permission.
This Quick Guide can be downloaded and printed for free . If you are a health care professional, we provide free, bulk copies of many of our resources. To make a request, visit TriageCancer.org/MaterialRequest .