Proudly Assisting with Your Medicaid Needs
Medicaid is a joint federal and state program that serves as the nation’s primary source of health coverage for low-income individuals.1 While the federal government sets broad guidelines, each state administers its own program, leading to variations in eligibility and specific benefits across the country.2
What is Medicaid?
At its core, Medicaid is an entitlement program that ensures individuals with limited financial resources can access necessary medical care.3 It is different from Medicare, which is a federal program primarily for people age 65 or older and those with specific disabilities, regardless of income.4
Today, Medicaid covers roughly 1 in 5 Americans, including children, pregnant women, parents, seniors, and people with disabilities.5
How People Qualify
Eligibility is generally determined by a combination of financial and non-financial factors.6
1. Financial Requirements
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Income Limits: Eligibility is usually based on Modified Adjusted Gross Income (MAGI).7 Under the Affordable Care Act (ACA), many states expanded Medicaid to cover nearly all adults with incomes up to 133% (effectively 138%) of the Federal Poverty Level (FPL).8
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Asset Tests: For some groups—such as seniors or those with disabilities—states may also look at “countable resources” or assets (like savings accounts).9 However, for most children and non-disabled adults, asset tests have been eliminated.10
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“Spend Down” Programs: In some states, if your income is slightly too high, you can qualify by “spending down” your income on medical expenses until it reaches the state’s limit.11
2. Non-Financial Requirements
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Categorical Eligibility: Historically, you had to fit into a specific category: child, pregnant woman, parent/caretaker, senior (65+), or person with a disability.12
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Residency & Citizenship: Applicants must be residents of the state where they apply and must be U.S. citizens or “qualified non-citizens” (such as lawful permanent residents).13
A Brief History
Medicaid was established on July 30, 1965, when President Lyndon B. Johnson signed the Social Security Amendments into law.14
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The Early Years: It began as a voluntary program for states to provide medical assistance to people receiving cash welfare.15
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The 1980s & 90s: Coverage was gradually expanded to include more pregnant women and children.16 In 1997, the Children’s Health Insurance Program (CHIP) was created to cover children in families that earned too much for Medicaid but too little for private insurance.17
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The Affordable Care Act (2010): The ACA fundamentally changed Medicaid by allowing states to expand eligibility to nearly all low-income adults.18 As of early 2026, 40 states and D.C. have adopted this expansion.19
Benefits and Coverage
Medicaid benefits are divided into Mandatory (federal requirement) and Optional (state choice).20
| Mandatory Benefits | Optional Benefits (Commonly Covered) |
| Inpatient & Outpatient hospital services | Prescription Drugs (covered by all states) |
| Physician services | Physical & Occupational therapy |
| Laboratory and X-ray services | Dental and Vision care for adults |
| Home health services | Clinic services |
| Nursing facility services (for 21+) | Respiratory care services |
| Transportation to medical care | Hospice care |
Special Benefit: EPSDT
For children under age 21, Medicaid provides the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.21 This is a comprehensive preventive health program that ensures children receive all necessary screenings and treatments, even if those services are considered “optional” for adults in that state.22