navigating Medicaid
Understanding Medicaid can be overwhelming, but it provides essential healthcare coverage for millions of Americans.
Key Medicaid Benefits
Medical Services
Medical Services
Medical Services
- Doctor visits and check-ups
- Hospital stays and emergency care
- Laboratory and X-ray services
Prescriptions
Medical Services
Medical Services
- Medication coverage
- Some states offer expanded drug formularies
- May include specialty medications
Long-Term Care
Medical Services
Long-Term Care
- Nursing home services
- Home health care
- Personal care services
Who Qualifies for Medicaid?
Mandatory Eligibility Groups
- Low-income families with children
- Qualified pregnant women
- Children under age 19 below income threshold
- SSI recipients (in most states)
Optional Eligibility Groups
- "Medically needy" individuals
- Working people with disabilities
- Individuals receiving home and community-based services
- Medicare beneficiaries with low income
Medicaid eligibility is determined by both financial criteria and categorical requirements. States that expanded Medicaid under the Affordable Care Act generally cover adults with income up to 138% of the Federal Poverty Level.
Special Pathways to Eligibility
Automatic Eligibility
Breast and Cervical Cancer Program
Automatic Eligibility
In most states, individuals receiving SSI benefits are automatically eligible for Medicaid without a separate application.
Children receiving Title IV-E adoption assistance or foster care payments also typically qualify automatically.
Former Foster Youth
Breast and Cervical Cancer Program
Automatic Eligibility
Young adults who were in foster care at age 18 are eligible for Medicaid until age 26, regardless of income.
This provision ensures continuity of healthcare during the transition to adulthood.
Breast and Cervical Cancer Program
Breast and Cervical Cancer Program
Breast and Cervical Cancer Program
Women diagnosed with breast or cervical cancer through the CDC's early detection program may qualify for Medicaid during treatment.
Income limits are often higher than standard Medicaid eligibility.
Application Processing Timeline
Application Received
Your application is logged into the system. For online applications, this is immediate. For mail applications, this may take several days.
Initial Review (1-2 weeks)
A caseworker performs an initial review to ensure all required information is present. You may receive a request for additional documentation if anything is missing.
Eligibility Determination (45 days typical)
Your application is fully evaluated against eligibility criteria. Income verification, citizenship checks, and other validation processes occur during this time
Decision (Up to 90 days)
Federal regulations require decisions within 90 days for disability-based applications and 45 days for all others. Many states process applications more quickly.
Presumptive Eligibility: Pregnant women, children, and some other groups may receive temporary Medicaid coverage while their full application is being processed.
