{"id":355789,"date":"2016-04-04T10:46:14","date_gmt":"2016-04-04T15:46:14","guid":{"rendered":"https:\/\/ability-fl-prod.internetbrands.com\/ability-law\/healthcare\/medicare-medicaid\/medicaid.html"},"modified":"2026-08-25T17:09:00","modified_gmt":"2026-08-25T22:09:00","slug":"medicaid","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/medicaid.html","title":{"rendered":"Medicaid: The Basics"},"content":{"rendered":"\n
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Medicaid: The Basics<\/h1>\n\n
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\n By Melissa McCall, J.D.<\/a> | Legally reviewed by Aviana Cooper, Esq.<\/a>\n | Last updated\n
\n \n <\/i>\n Legally Reviewed\n <\/summary>\n\n
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This article has been written and reviewed for legal accuracy, clarity, and style by FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with our editorial standards<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n\n

\n \n <\/i>\n Fact-Checked\n <\/summary>\n\n
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The last updated date refers to the last time this article was reviewed by FindLaw or one of our contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please contact an attorney in your area<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n<\/section>\n\n\n

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Key Takeaways<\/h2>\n

Medicaid is a federally mandated, state-administered program providing health coverage to low\u2011income U.S. citizens and lawful residents, with each state setting its own eligibility rules. Coverage includes mandatory services like hospital care, preventive screenings, and transportation, while optional benefits\u2014such as dental or prescription drugs\u2014vary by state.<\/p>\n\n <\/div>\n <\/div>\n<\/div>\n\n

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Applicants can enroll through the Marketplace or their state agency, and if denied, they have the right to appeal within state\u2011specific deadlines.<\/p>\n

Medicaid helps ensure that low-income adults and children can access long-term care and healthcare services, leading to better health outcomes for more people. Individual states and the federal government jointly administer Medicaid through cost-sharing.<\/p>\n

The following article highlights the basics of Medicaid<\/a>, including eligibility, coverage, and how to apply for benefits.<\/p>\n

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Understanding Medicaid processes, appeals, and eligibility can be overwhelming and confusing. But legal help is available. Talk to a healthcare attorney in your state<\/a> for targeted legal advice.<\/p>\n

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Medicaid Basics<\/h2>\n

The U.S. Department of Health and Human Services (HHS) jointly administers this medical assistance program with individual states and through the Centers for Medicare and Medicaid Services (CMS).<\/p>\n

As of April 2026, the total number of Medicaid enrollees exceeds 66 million<\/a>. States receive federal funding to administer Medicaid, and they can tailor their Medicaid programs to achieve their long-term healthcare goals. Since states administer Medicaid, each state can set its eligibility requirements.<\/p>\n

States must follow CMS regulations in tailoring their programs. States can apply for CMS waivers to try out new programs.<\/p>\n

Medicaid Expansion<\/h3>\n

President Barack Obama signed the\u00a0Patient Protection and Affordable Care Act<\/a> (ACA) into law in 2010. The intent of the ACA includes expanding health care coverage for low-income adults. The ACA does this by subsidizing health insurance premiums. Another way is through the\u00a0Medicaid Expansion<\/a>.<\/p>\n

Before the ACA, some low-income adults could not qualify for Medicaid because their incomes were too high. They earned too much money to qualify for medical assistance but not enough to afford insurance premiums. In states with expanded Medicaid, low-income adults can qualify<\/a> if their incomes are at or below 133% of the\u00a0federal poverty level<\/a>.<\/p>\n

Medicaid Eligibility<\/h2>\n

The primary factor determining\u00a0Medicaid eligibility<\/a> is income level. The second eligibility factor is citizenship. Only U.S. citizens or lawful permanent residents can enroll in Medicaid.<\/p>\n

Medicaid waives this requirement for people with emergency medical conditions, including pregnant women in labor. Some states also offer non-emergency prenatal coverage for pregnant women regardless of immigration status<\/a>.<\/p>\n

Children from families with incomes above the Medicaid coverage threshold may be eligible for health care benefits through the Children’s Health Insurance Program<\/a>\u00a0(CHIP).<\/p>\n

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Medicaid coverage, processes, and eligibility rules vary by state. Find local legal help<\/a>.<\/p>\n

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Financial Eligibility for Medicaid<\/h3>\n

For Medicaid eligibility income purposes, states use a household’s modified adjusted gross income (MAGI). MAGI is the\u00a0adjusted gross income<\/a>\u00a0plus any of the following:<\/p>\n