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Your comprehensive guide to understanding, applying for, and maintaining Medicaid benefits
Medicaid is a joint federal-state program that provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.
As of 2025, Medicaid covers approximately 71.2 million people nationwide, making it one of the largest health insurance programs in the United States.
Entitlement program: Eligible individuals have rights to payment for medically necessary health care services
Joint federal-state program: The federal government funds a share of the costs, while states administer the program
Comprehensive coverage: Includes benefits not typically covered by other insurers
State variability: Each state establishes its own eligibility standards and benefits
71.2 million people covered
17.8% of national healthcare spending
56 different state/territory programs
1965 year established
Medicaid eligibility varies by state but follows federal guidelines. Understanding if you qualify is the first step to accessing this important healthcare coverage.
Low-income families who meet certain income requirements
Many states set higher income limits for pregnant women
Including those in higher-income families in some cases
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Adults 65 and older who meet income requirements
Including those receiving SSI benefits
Adults under 65 with income up to 138% FPL
Income eligibility is typically based on the Federal Poverty Level (FPL), which changes yearly.
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Even if you think you might not qualify, it's worth applying. Eligibility rules are complex and change frequently, especially if you have children, are pregnant, or have a disability.
The best way to determine if you qualify for Medicaid is to apply through your state's Medicaid agency or the Health Insurance Marketplace.
Learn how to apply?Applying for Medicaid is a straightforward process, but it varies by state. Here's what you need to know to complete your application successfully.
Submit application
State reviews application and may request additional documentation
Most states process applications within 45 days
Disability-based applications may take up to 90 days
You'll receive information about your benefits and how to use them
The notice will explain why and how to appeal the decision
Free assistance is available from:
Certified application counselors
Navigators
State Medicaid office staff
Local community organizations
Once you've been approved for Medicaid, it's important to understand how to maintain your coverage to avoid any gaps in your healthcare.
States first try to renew your coverage automatically without requiring action from you:
If your state can't verify your continued eligibility automatically:
You must report certain changes to your state Medicaid agency when they happen:
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You must report certain changes to your state Medicaid agency when they happen:
Keep your contact information updated so you receive renewal notices
Respond promptly to all requests for information
Set calendar reminders for your annual renewal date
Keep copies of all documents you submit
Follow up if you don't receive confirmation of your renewal
You have the right to appeal the decision if you believe it was made in error
Many states will reopen your case without a new application if you respond within 90 days
If you no longer qualify for Medicaid, your information may be transferred to the Health Insurance Marketplace
You can submit a new application if your circumstances change
If you're eligible for both Medicare and Medicaid, you're considered "dual eligible." Understanding how these programs work together can help you maximize your benefits and minimize your healthcare costs.
Dual eligibility means you qualify for both Medicare and Medicaid:
Medicare is a federal health insurance program primarily for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD).
Medicaid is a joint federal and state program that provides health coverage for people with low income.
If you have full dual eligibility, Medicaid helps pay for:
For Medicare-covered services
For covered services after Medicare and other insurance have paid
Services that Medicare doesn't, such as long-term care
Automatic qualification for Extra Help (Low-Income Subsidy) with Medicare Part D costs
No premium or deductible if you join a standard Medicare drug plan
Very low or no copayments for covered drugs
Very low or no copayments for covered drugs
Very low or no copayments for covered drugs
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Automatic qualification for Extra Help (Low-Income Subsidy) with Medicare Part D costs
No premium or deductible if you join a standard Medicare drug plan
Very low or no copayments for covered drugs
No coverage gap ("donut hole")
Ability to change Medicare drug plans once per calendar quarter during the first three quarters of the year
Present both your Medicare and Medicaid cards when receiving services
Confirm that your providers accept both Medicare and Medicaid
Know that providers must bill Medicare first, then Medicaid
Contact your State Health Insurance Assistance Program (SHIP) for free personalized counseling
Stay informed about the latest changes to Medicaid policies and regulations that may affect your coverage and benefits.
The One Big Beautiful Bill Act (H.R.1) recently passed in the House of Representatives and includes several significant proposed changes to Medicaid:
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Proposed legislation may change significantly before becoming law, and implementation timelines vary. For the most current information, always refer to official government sources or contact your state Medicaid office directly.
Find out if you qualify for Medicaid coverage and apply today.
Before he became the go-to guru for government benefits on his YouTube channel, MyGovExpert, Dr. Ed was a District Manager for the Social Security Administration. That's right, he wasn't just reading the rulebook; he was living it, managing the folks who make the decisions. If you've ever felt like SSA speaks a different language, Dr. Ed is your translator. He's seen it all, heard it all, and now he's here to share that invaluable insider experience with you, cutting through the red tape with a healthy dose of common sense (and maybe a terrible joke or two).
But his journey didn't start there. Long before navigating bureaucratic hall ways, Dr. Ed served his country with distinction as a Sergeant in the United States Marine Corps. Semper Fi! That discipline and commitment to service are still a core part of who he is today.
His dedication to public service also led him to a role as a Family Services Specialist with the Department of Social Services, giving him a broad perspective on the challenges many people face. And because he apparently doesn't believe in free time, Dr. Ed has also been shaping young minds as a University Adjunct Professor.
With a PhD to his name and a wealth of real-world experience, Dr. Ed Weir isn't just an expert; he's your expert. He's passionate about helping people understand their benefits and get what they're entitled to. So, if you're looking for some one who can explain complex government stuff in plain English, with a bit of humor and the authority that only comes from having been there, you've found your guy.
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