Medicaid information and assistance

What Medicaid is, in plain terms

Medicaid is a joint federal and state program that pays for health care for people with limited income and resources. The federal government sets a floor — groups every state has to cover, and benefits every state has to include — and each state builds on top of that floor with its own rules, its own name for the program, and its own application system.

That is the single most important thing to understand before you read anything else. Two neighbors in different states, with identical incomes and identical health needs, can get different answers. Nationally the program covers more than 77.9 million people, but there is no one national eligibility test.

Only your state agency can decide whether you qualify. Nobody at an insurance brokerage can approve you, deny you, or speed you up. What we can do is explain the terms, tell you which door to knock on, and make sure a Medicare decision is not made in ignorance of a benefit you already qualify for.

Who qualifies: the main eligibility groups

Eligibility is sorted into categories rather than assessed as one general test. Almost everyone who qualifies does so through one of the following routes.

Groups every state must cover

Federal law requires states to cover low-income families, qualified pregnant women and children, and people receiving Supplemental Security Income. These are the mandatory groups, and they exist everywhere, though the income cut-offs still vary from state to state.

The expansion adult group

The Affordable Care Act allowed states to extend coverage to adults with income at or below 133% of the federal poverty level. Because of a standard five-percentage-point income disregard, this is usually described in practice as 138%. Adopting it is a state choice: 41 states including the District of Columbia have adopted the expansion, and 10 have not. In a state that has not adopted it, a low-income adult with no children and no disability often has no eligibility category at all.

People who are aged, blind, or have disabilities

These applicants are assessed outside the income rules used for families and children. Their eligibility generally follows the income methods of the Supplemental Security Income program, and resources — savings and assets, not just monthly income — are counted. A group of states known as 209(b) states may apply criteria stricter than SSI’s. This is also the route that matters most for long-term care and nursing-home costs, which Medicare does not pay for beyond limited short-term skilled nursing.

Medically needy and spend-down

If your income is above the limit but your medical bills are large, many states let you subtract those bills from your income until you reach the qualifying level. Thirty-six states and the District of Columbia run spend-down programs of this kind. People rule themselves out on income alone and never find out this exists; it is worth asking about directly.

Where Medicaid meets Medicare

This is the part most relevant to the people we work with, and the part most often missed.

You can have both. People enrolled in both Medicaid and Medicare are called dual eligibles. When that happens, Medicare pays first and the state program fills in behind it — picking up premiums, cost sharing, and services Medicare never covered, most notably long-term care. Dual eligibles also qualify automatically for Extra Help with prescription costs, and in most areas they can choose a Dual Eligible Special Needs Plan built for people in exactly that position.

Even if you do not qualify for full coverage, you may qualify for help with Medicare’s own costs through the four Medicare Savings Programs. These are administered by the state, and the 2026 monthly income limits are as follows.

QMB, SLMB and QI also carry a resource limit of $9,950 for an individual and $14,910 for a married couple in 2026; QDWI uses $4,000 and $6,000. Several states apply higher limits than these or ignore resources entirely, and some disregard certain income, so an application is worth making even if you look slightly over. QMB carries one protection worth knowing about on its own: providers are not permitted to bill you for Medicare deductibles, coinsurance or copays.

CHIP, for children in families who earn too much to qualify

The Children’s Health Insurance Program covers children whose household income is above the Medicaid line but well below what private cover costs. Around 9.6 million children are enrolled. Some states run CHIP inside their existing Medicaid program and some run it separately, and the income ceilings are considerably higher than most parents expect.

Two things make CHIP worth checking early. Children can be eligible while their parents are not, so a household can end up legitimately split across programs. And applications are accepted all year rather than only during Open Enrollment, so there is no window to miss.

How this looks in the states we serve

We are licensed in several states, and the differences are real.

Nevada. Medicaid is run by the Division of Health Care Financing and Policy, and the state adopted the expansion adult group, so low-income adults under 65 have a category to apply under.

Illinois. Administered by the Department of Healthcare and Family Services under the Medical Assistance banner. Illinois also adopted the expansion.

Mississippi. Administered by the Mississippi Division of Medicaid, which has not adopted the expansion adult group. Eligibility there runs through the traditional categories — children, pregnant women, parents at very low incomes, and people who are aged, blind or have disabilities — alongside CHIP and the state’s MississippiCAN managed care program.

If you have moved recently, assume nothing carries over. Coverage does not travel between states; you close the old case and apply fresh in the new one, and there is usually a gap unless you start early.

How to apply for Medicaid, and what to have ready

There are two official routes and both are free. Apply directly to your state agency, or apply through HealthCare.gov, which forwards your information to the state when it looks as though you qualify. Applying through the Marketplace has an advantage: if you turn out not to be eligible, the same application is assessed for Marketplace savings instead, so you are not left starting over.

Have proof of income, proof of citizenship or immigration status, dates of birth for everyone in the household, and — for the aged, blind and disabled route — statements showing savings and assets. Applications stall on missing paperwork far more often than they are refused on the merits.

One warning worth taking seriously. Nobody legitimate charges a fee to file this application, and no honest caller asks for your Social Security number or bank details out of the blue to “check your eligibility”. Send documents only through your state’s own portal or office.

What a licensed agent can and cannot do here

We are a licensed insurance brokerage, not a government office, and we are paid by insurance carriers rather than by you. Being straight about the boundary matters.

We cannot determine your eligibility, submit a state application on your behalf, or influence a decision that has already been made. What we can do is check whether a Medicare Savings Program or Extra Help looks likely before you enroll in anything, tell you when a Dual Eligible Special Needs Plan is worth comparing, explain a denial notice and where the appeal goes, and point you at the right office rather than a call center. Where the answer is “this belongs with the state”, we will say so and hand you the number.

Medicare reference charts

The charts below cover the ground most questions start from.

Check any of this independently

Every figure above comes from a public source you can read yourself, free of charge.

• Medicaid.gov — eligibility — the federal groups, income rules and spend-down programs described above
• Medicare.gov — Medicare Savings Programs — the 2026 income and resource limits in the table
• Medicaid.gov — CHIP — children’s coverage and state-by-state rules
• KFF — status of state expansion decisions — which states have adopted the expansion adult group
• HealthCare.gov — the single application that checks both routes

Related guides on this site

• Individual and family health insurance — the Marketplace route if you are over the income line
• Medicare Advantage plans — including special needs plans for dual eligibles
• Part D prescription drug plans — where Extra Help applies
• Book a no-cost appointment

Or call (877) 808-2900. If it turns out the state is the right place for your question, we will tell you plainly and give you the office that handles it.