What is the shared federal and state health insurance program for low-income persons called?

Medicaid is a joint federal-state program that provided health care coverage to an estimated 70.2 million people in fiscal year (FY) 2019. As a major payer in the U.S. health care system, it accounted for about 16.2 percent of national health care spending in calendar year 2019.

Medicaid’s role among payers is unique. It provides coverage for health and other related services for the nation’s most economically disadvantaged populations, including low-income children and their families, low-income seniors, and low-income people with disabilities. These populations are distinguished by the breadth and intensity of their health needs; the impact of poverty, unemployment, and other socioeconomic factors on their ability to obtain health care services; and the degree to which they require assistance in paying for care. Medicaid provides benefits not typically covered (or covered to a lesser extent) by other insurers, including long-term services and supports. It also pays for Medicare premiums and cost sharing for more than 12 million people who are enrolled in both programs. It is also a major source of financing for care delivered by certain providers, particularly safety net institutions that serve both low-income and uninsured individuals.

The Medicaid program was enacted as part of the Social Security Amendments of 1965 (P.L. 89-97), the same legislation that created Medicare. Like Medicare, Medicaid is an entitlement program. Eligible individuals have rights to payment for medically necessary health care services defined in statute; the federal government is obligated to fund a share of the outlays for those services.

Variability in Medicaid is the rule rather than the exception. States establish their own eligibility standards, benefit packages, provider payment policies, and administrative structures under broad federal guidelines, effectively creating 56 different Medicaid programs—one for each state, territory, and the District of Columbia. States also differ in Medicaid financing. Learn more about different aspects of Medicaid by following the links below.

Click here for information on CHIP. Click here for federal legislative milestones in Medicaid and CHIP.

Subtopics

• Putting the program in context
• Eligibility
• Benefits
• Financing
• Provider payment and delivery systems
• Waivers
• Administration
• Spending

Medicaid is a federal and state health insurance program for people with a low income.

The Children’s Health Insurance Program (CHIP) offers health coverage to children. To be eligible, the child's family must have an income that is:

• Too high to qualify for Medicaid
• Too low to afford private coverage

Medicaid and CHIP program names are different in each state.

Learn About Medicaid

What help is available through Medicaid?

Medicaid provides free or low-cost medical benefits to eligible:

• Adults with a low income
• Children
• Pregnant women
• People who are age 65 or over
• People with disabilities

Am I eligible for Medicaid?

Check with your state’s Medicaid office to see if you or your family members are eligible for benefits. In general, it depends on at least one or a combination of:

• Age
• Income level
• Number of people in your family
• If you are pregnant or have a disability

How do I apply for Medicaid?

There are two ways to apply for Medicaid:

• Contact your state Medicaid agency. You must be a resident of the state where you are applying for benefits.
• Fill out an application through the Health Insurance Marketplace.

Learn About the Children’s Health Insurance Program (CHIP)

If your income is too high for Medicaid, your child may still qualify for the Children’s Health Insurance Program (CHIP). It covers medical and dental care for uninsured children and teens up to age 19.

Is my child eligible for CHIP?

CHIP qualifications are different in every state. In most cases, they depend on income.

How do I apply for CHIP benefits?

You have two ways to apply for CHIP:

• Find a program by state, or call the Health Insurance Marketplace at 1-800-318-2596 (TTY: 1-855-889-4325).
• Fill out an application through the Health Insurance Marketplace.

What else do I need to know about CHIP?

• You can apply for and enroll in Medicaid or CHIP anytime during the year.
• Learn how to use your Medicaid or CHIP coverage.

• Like Medicaid and CHIP, the Basic Health Program (BHP) offers affordable, continuous coverage. It’s an optional program that your state may offer. It’s available to people with incomes that shift above and below Medicaid or CHIP levels.
• Get information on other common types of health insurance, such as Medicare, and find help paying for medical bills.

File a Complaint About Medicaid or CHIP

If you have a problem with Medicaid or CHIP services, you can file a complaint. These programs are managed by each state rather than the federal government. Contact your state's Medicaid program to report your issue.