Eligibility

Medicaid covers people who would otherwise face considerable financial barriers to health care. Generally, a person must fall into a specific population group, referred to as categorical eligibility, and meet income thresholds in order to be eligible for Medicaid. Federal law mandates some of these eligibility groups; some are covered at state option. All states offer Medicaid coverage for low-income children, their parents, expectant mothers, seniors, and people with disabilities; some states have opted to expand eligibility further. To receive a full range of Medicaid benefits, individuals also must be U.S. citizens or qualified aliens. Learn more about eligibility pathways, eligibility and enrollment processes, and issues pertaining to specific populations.

Learn more

Featured publications

Medicaid Home and Community-Based Services: Characteristics and Spending of High-Cost Users

June 2018 | ,

Medicaid enrollees increasingly are receiving long-term services and supports (LTSS) through home and community-based services (HCBS). This fact sheet describes the characteristics and service use of Medicaid enrollees who used HCBS in 44 states in 2012, and analyzes Medicaid spending for these HCBS users. We focused particularly on high-cost users, defined as the 3 percent […]
Read More >>

Federal Requirements and State Options: Eligibility

March 2017 |

Medicaid eligibility is typically defined in terms of both categorical eligibility (the populations covered) and financial eligibility (the income levels or thresholds at which the populations can be covered). Federal statute and regulations require coverage of certain eligibility groups, while others may be covered as a state option. States also have some flexibility to establish […]
Read More >>

The Intersection of Medicaid and Child Welfare

June 2015 |

In fiscal year 2011 nearly 1 million children were eligible for Medicaid based on their receipt of child welfare assistance. While the population is small relative to the rest of the Medicaid program—accounting for less than 1 percent of all Medicaid enrollees and about 3 percent of children enrolled on a basis other than disability—their […]
Read More >>