Medicaid 101
Friday, March 21, 2025
Reviewed by Boys Town Patient Financial Services
Most people have heard of Medicaid, the government healthcare program for families, children and seniors. But what is it, really?
Medicaid is, in simple terms, a program that pays the medical costs of individuals in groups with limited incomes. In slightly less simple terms, Medicaid is a program run by the federal government and individual states to provide coverage for healthcare, from primary care to inpatient hospital services and nursing facility care, for people who are at or below a certain income level.
Low-income groups that can use Medicaid services include:
- Children and their families
- Seniors (65 and older)
- Individuals with disabilities
Eligibility Requirements
You may be wondering how much is considered “low income." The federal minimum income for children and pregnant people to qualify for Medicaid is currently 133% of the federal poverty level (FPL), or approximately $35,630 per year for a family of three (the 2024 FPL is $25,820). Please refer to your state of residence for further eligibility requirements, as state requirements vary.
For seniors and those with disabilities who have low incomes, eligibility varies substantially by state. There is also no Modified Adjusted Gross Income (MAGI) pathway for seniors or individuals with disabilities, so qualifying is more complicated.
Click the following states to learn more about eligibility.
Applying for Medicaid
Individuals must apply for Medicaid through their state's website; this means creating an account and providing certain documents and information. While this varies by state, it may include:
- Name and date of birth
- Social Security number
- Monthly payments for rent, mortgage and/or utilities
- Proof of citizenship or immigration status
- Proof of income, such as pay stubs or your W-2
- Verification of other government benefits (if you receive any)
- Insurance information, either through an employer or independently
Medicaid vs. CHIP
Another program for families is the Children's Health Insurance Program (CHIP). Your child(ren) may qualify for CHIP if your income is too high for Medicaid. CHIP covers dental and medical care for uninsured children up to 19 years old.
In most states, children in families with income up to $80,000 per year for a family of four may qualify (please note that this varies from state to state). Eligibility information for CHIP is available on your state's website.
Sources:
InsureKids.Gov: Frequently Asked Questions
