Medicaid
Health Insurance for Low-Income Americans
Quick Facts
Federal FY 2025 Budget
$600 Billion
Total w/ State Funding
$1+ Trillion
Enrollees
90+ Million
Children, adults, elderly, disabled
States Participating
All 50
Plus DC & territories
How Medicaid is Funded
Medicaid is a joint federal-state program with shared funding responsibilities:
- Federal matching: Federal government pays 50-83% of costs depending on state income levels
- State contributions: States provide remaining funding and administer programs
- Enhanced matching: Medicaid expansion states receive 90% federal match for expansion population
- General tax revenue: Federal share comes from general federal tax revenue, not payroll taxes
Note: Medicaid is the largest source of federal funding to states, and states have significant flexibility in how they design and operate their programs within federal guidelines.
What Medicaid Covers
Required Benefits
All state Medicaid programs must cover: physician services, hospital care, laboratory and X-ray services, nursing facility care, home health care, preventive care for children, family planning services, and rural health clinic services.
Long-Term Care
Medicaid is the nation's largest payer of long-term care services, covering nursing home care, assisted living, and home and community-based services for elderly and disabled individuals. Medicare does not cover long-term custodial care.
Children's Health
Comprehensive coverage for children including Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, dental care, vision care, and behavioral health services. Nearly 40% of all children in the U.S. rely on Medicaid or CHIP.
Behavioral Health Services
Mental health and substance use disorder treatment, including inpatient and outpatient services, therapy, counseling, and medication-assisted treatment. Medicaid is the single largest payer of mental health services in the U.S.
Prescription Drugs
Outpatient prescription drug coverage with minimal copayments for most beneficiaries. Medicaid receives statutory rebates from drug manufacturers, making it a major influence on pharmaceutical pricing.
Who Qualifies for Medicaid
Eligibility varies by state, but generally includes:
Low-Income Families
Parents and children in families with income up to 138% of federal poverty level (expansion states) or lower thresholds in non-expansion states
Pregnant Women
Coverage for prenatal care, delivery, and postpartum care for low-income pregnant women
People with Disabilities
Individuals receiving Supplemental Security Income (SSI) due to disability
Seniors Needing Long-Term Care
Low-income elderly individuals requiring nursing home or home-based care
Where Medicaid Spending Goes
Though only 25% of enrollees, accounts for majority of spending due to long-term care costs
Working-age adults, including expansion population
Nearly half of all enrollees but lower per-person costs
Program administration and eligibility determination