Is Medicaid a state or federal program?

Medicaid is the largest public health insurance program in the U.S., even larger than Medicare. It covers essential health services for millions of people with low-incomes.

While the federal government provides guidance on who is eligible and how Medicaid should work, your state is generally responsible for operating the program and creating exact policies.

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Who sets the rules for how Medicaid works?#who-sets-the-rules-for-how-medicaid-works

Both the federal government and your state set the rules for Medicaid.

The federal government provides general guidance that states must follow and oversees the program at a national level. This includes writing rules about things like:

• Minimum eligibility criteria for groups like children, pregnant people (called Pregnancy Medicaid), and individuals with disabilities
• What benefits Medicaid must cover (like doctors visits and prescriptions)
• What information states must report to the federal government to continue receiving funds
• Who is eligible for dual Medicaid and Medicare (enrolling in both programs at the same time)

States get to decide how to run their programs day-to-day, set policies within federal guidelines, and are responsible for delivering services to their residents. States can also expand eligibility and covered services beyond federal minimums.

What parts of Medicaid vary by state?#what-parts-of-medicaid-vary-by-state

Because states have flexibility to change rules within federal guidelines, Medicaid can look and work differently depending on where you live.

Things that may vary by state include:

• Income limits for Medicaid eligibility (often based on the federal poverty level)
• Whether the state expanded Medicaid to cover more adults
• Covered services beyond those required by the federal government (like assisted living, dental, vision, or braces)
• Whether you receive care through managed care plans—a private health insurance company that states contract with to provide Medicaid benefits
• Copays or cost-sharing rules (the exact costs you pay for care)
• How Medicaid work requirements are enforced

This is why two people in different states may experience Medicaid differently.

Who funds Medicaid?#who-funds-medicaid

Medicaid represents almost one-fifth of every dollar spent on health care in the U.S. with 68.8 million people participating in the program. Both the federal government and individual states share the costs, but the federal government often pays a larger share.

Is Medicaid free?#is-medicaid-free

Medicaid is meant to help people with low-incomes, so in most cases, it is free or very low cost and you will pay $0 in monthly premiums. Some services may have small copays, but usually just a few dollars because costs are limited by federal rules to keep care affordable.

Is Medicaid an entitlement program?#is-medicaid-an-entitlement-program

Yes, Medicaid is considered an entitlement program.

That means if you meet the eligibility requirements in your state, you have a legal right to receive coverage. The program does not have a fixed number of slots and anyone who applies and qualifies can enroll.

How do I apply for Medicaid?#how-do-i-apply-for-medicaid

You can apply for Medicaid at any time during the year—there is no enrollment period.

There are multiple ways to get started:

• Visit your state Medicaid website
• Go to the federal Health Insurance Marketplace website (which may redirect you to your local state website)
• Contact a local social services or Medicaid office and apply in person, by phone call, or by mail-in application

For step-by-step instructions, see our guide on how to apply for Medicaid in three steps.