Is Medicaid the Same in Every State? Rules & Coverage Guide
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Medicaid acts as a lifeline for millions of low-income Americans, yet the question remains “is Medicaid the same in every state”?
While it follows a federal regulatory framework, each state has the authority to adjust its benefits, eligibility criteria, and administrative processes.
This results in significant variations in Medicaid programs across states, directly affecting participants’ coverage, access to services, and overall healthcare experience.
1. Is Medicaid the Same in Every State?
Medicaid is known as a public health program managed under a “federal framework – state implementation” model. This means Medicaid is not exactly the same in every state.
While all states must follow minimum federal standards, each state has the authority to adjust the specific details of its own program.
As a result, Medicaid benefits, eligibility criteria, and administrative processes can differ significantly depending on where you live.
Medicaid is built on a partnership between the federal government and state governments.
At the federal level
The Centers for Medicare & Medicaid Services (CMS) establishes general rules and lists the mandatory benefits that all states must provide.
The federal government also funds part of the costs through the Federal Medical Assistance Percentage (FMAP) cost-sharing formula.
On the state level
Every Medicaid agency has the authority to oversee and define how the program operates within its borders:
- Determining eligible groups (following the federal framework but with the option to add its own criteria).
- Deciding whether to expand optional services such as adult dental care, vision care, and non-emergency medical transportation (NEMT).
- Choosing the delivery model (fee-for-service or managed care).
- Establishing the application, review, and renewal processes for coverage.
States can customize their Medicaid programs because federal law allows customization within certain limits. The main mechanisms include:
- State plan options: Add optional services, expand coverage, or modify service delivery.
- Waivers: Section 1115 (test new care or funding models) and Section 1915(b)/(c) (mandate managed care or expand home/community-based services).
- Flexible cost sharing: States decide whether to charge copays and at what level, within federal limits.
These flexibilities allow each state to build a Medicaid program that aligns with its budget, healthcare needs, and strategic priorities.
>>> Read more: What Are The Medicaid Cuts 2025 And What Does It Mean?
2. Medicaid Eligibility by State
Because Medicaid operates under a “federal framework – state implementation” model, eligibility has some nationwide standards, but specific income thresholds and criteria vary by state.
Understanding in detail the factors that influence eligibility and how to check your state’s requirements will save you time and help ensure you don’t miss out on benefits you may qualify for.
Factors that affect eligibility
Medicaid eligibility depends on multiple factors, including categorical group, income, residency status, and whether the state has expanded Medicaid.
Categorical groups
Federal law requires states to cover certain groups and allows optional coverage for others, such as:
- Children
- Pregnant women
- Parents/caregivers
- Low-income adults
- And aged/blind/disabled (ABD) individuals, each with their own financial and non-financial rules.
Income & methodology
Most groups use MAGI (Modified Adjusted Gross Income) rules based on tax law to determine household size and income.
For ABD groups, states frequently apply non-MAGI regulations that include asset testing.
In certain states, a “Medically Needy” or “Spend-Down” pathway is available, allowing applicants to qualify once medical expenses are subtracted from their income.
Residency & immigration status
Applicants must reside in the applying state and meet citizenship or qualified immigration requirements.
Undocumented individuals may receive limited emergency coverage under federal law.
Adult expansion (ACA)
Expansion states cover most non-disabled adults without dependents up to 138% FPL. Non-expansion states typically have stricter criteria.
State-specific rules
States can adjust FPL limits, set allowable cost-sharing, or require extra documents thereby creating significant eligibility differences nationwide.
How to check your state’s Medicaid eligibility?
Step 1: Identify your group & applicable income threshold
Determine your category (children, pregnant women, low-income adults, ABD, etc.) and whether income is calculated using MAGI or non-MAGI. Note any required assets or income disclosures.
Step 2: Check your state’s Medicaid expansion status
In expansion states, non-disabled adults without dependents may qualify if income ≤ 138% FPL. In non-expansion states, explore options like parent/caregiver categories or medically needy/spend-down.
Step 3: Access your state’s official Medicaid profile
Visit Medicaid State Profiles or your state’s Medicaid/CHIP site for current FPL limits, rules, forms, and application methods.
Step 4: Use online screening tools and apply
Go to healthcare.gov or your state’s Marketplace portal to check eligibility and be directed to your state Medicaid agency.
Step 5: Prepare and verify non-financial requirements
Provide proof of residency, citizenship/immigration, and other documents. States often confirm immigration status through DHS’s SAVE system.
3. Medicaid Availability in All States
Is Medicaid in all 50 states?
Medicaid is available in all 50 states, Washington, D.C., and most U.S. territories. However, each state may use its own name for the program, which can sometimes confuse residents who may not realize they are enrolled in Medicaid.
For example:
- Medi-Cal (California)
- MassHealth (Massachusetts)
- Apple Health (Washington)
- TennCare (Tennessee)
- KanCare (Kansas)
- SoonerCare (Oklahoma)
- BadgerCare Plus (Wisconsin)
- or Cardinal Care (Virginia).
However, not every state has adopted Medicaid expansion under the Affordable Care Act (ACA). As of 2023, 40 states and D.C. have expanded Medicaid, while 10 states have not.
Can you use Medicaid anywhere in the US?
Medicaid coverage is limited to the state where you reside. You generally cannot use Medicaid while temporarily in another state, except in life-threatening emergencies, in which case Medicaid may cover the cost.
Even then, not all out-of-state hospitals accept Medicaid; if the facility is not an enrolled provider in your state’s Medicaid program, it may refuse direct billing and require you to pay upfront.
Beyond emergencies, Medicaid may cover out-of-state care only if:
- You receive pre-authorization from your state’s Medicaid agency.
- A healthcare provider is only covered if they are registered with the Medicaid program in your state of residence.
Meeting these requirements is uncommon, and the process can be complicated. When relocating to another state, your Medicaid benefits won’t carry over automatically.
You’ll need to close your case in the former state and reapply in the new one, since eligibility rules differ from state to state.
4. Which State Has the Best Medicaid Program?
There is no single state considered the absolute “best” for Medicaid, as each designs its program based on its population’s needs, available budget, and healthcare policies.
However, several states stand out for unique benefits and initiatives worth noting.
- California: Medi-Cal offers wide-ranging services, from whole-person care and social–health initiatives (HRSN, SDOH) to an extensive HCBS network and leads in innovative SPA/waiver projects.
- New York: Broad coverage with strong mental health programs, community services, and a large provider network for easier access to care.
- Massachusetts: Integrated healthcare system with high service quality and strong health outcomes, consistently ranking well nationwide.
- Oregon & Washington: Run multiple social–health (SDOH) pilots and expand community support via Section 1115 waivers.
- Minnesota & New Jersey: Longstanding adult dental coverage and solid HCBS support, particularly for low-income and older residents.
When evaluating Medicaid programs in different states, three main criteria can help you compare benefits and assess program quality:
- Scope of benefits: A broader range of benefits enables residents to access more essential services, improving overall health outcomes.
- Application & processing speed: States that utilize digital systems and automated verification often process applications faster, allowing residents to receive benefits in a timely manner.
- Level of expansion & policy support: Reflects a state’s commitment to expanding healthcare coverage for low-income individuals and vulnerable populations.
5. How to Maximize Additional Benefits with Medicaid?
If you are receiving Medicaid, you can further expand your practical benefits by joining federal assistance programs for low-income households, most notably, Lifeline.
Lifeline can help offset your communication costs (phone/internet), enabling you to stay connected to healthcare services, employment opportunities, and community support, all of which are highly valuable when accessing medical care.
To participate, you must meet income requirements or be enrolled in programs such as Medicaid. Lifeline only provides subsidies or discounts for mobile and Internet services; it is not a government program that directly gives out free devices.
However, through certain carriers, you may be able to receive free devices provided by the carrier itself.
AirTalk Wireless is one of the providers that offers extended benefits through Lifeline. AirTalk Wireless provides free or discounted plans for eligible customers, including unlimited data, talk, and text.
In some states or during specific promotional campaigns, they may also offer a free smartphone to new subscribers (availability varies by state and timing).
Be sure to thoroughly research both the program and the provider so you don’t miss the opportunity to maximize your benefits for yourself or your family through Medicaid.
>>> Read more: The Truth About Free Apple Tablets from Government Programs
Final Words
Understanding if Medicaid is the same in every state will help you maximize your healthcare benefits according to where you live. Start today by visiting your state’s official website to review eligibility criteria and apply for Medicaid, making sure you don’t miss any benefits you deserve.
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