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Medicaid and the Health Care Law

This information is also available in Spanish.

What is Medicaid?

Medicaid is a government program that covers the cost of medical care for low-income people who meet certain criteria. To enroll in Medicaid, your family’s income and assets must be below a certain level. These levels vary from state to state.

While Medicaid is funded by federal and state governments, health care is provided by both public and private health care providers and plans.

Am I eligible for Medicaid coverage?

Some examples of people who have long been eligible for Medicaid include low-income pregnant women, children, adults with dependent children, people with disabilities, and those age 65 and older.

Under the health care law called the Affordable Care Act, states have the option to give more people access to Medicaid coverage by including everyone below a certain income level – about $16,000 for one person and roughly $33,000 for a family of 4.

In states that chose to accept federal money to improve access to Medicaid, many people who didn’t have insurance are now able to get lifesaving preventive care and treatments for cancer and other serious diseases. In states that have not broadened access to Medicaid coverage, many low-income people remain uninsured.

Legal permanent residents (also known as green card holders) may have to wait 5 years before they can enroll in Medicaid. Undocumented immigrants are generally not eligible for Medicaid.

Will Medicaid provide the health coverage I need?

Medicaid covers a range of health services, including doctor visits, hospital care, lab and x-ray services, and prescription drugs. People who are “newly eligible” in states that expand access to Medicaid are also covered for health care services to help prevent and treat serious diseases, such as cancer.

Not all health providers take patients with Medicaid. It’s important to be sure that the doctor you want to see will accept Medicaid before making an appointment. If they don’t, you may have to pay for the full cost of the visit.

How do I enroll?

You can apply for Medicaid at any time – you don’t have to wait for special enrollment periods. You can find out if you qualify for Medicaid through your state’s health insurance marketplace.

If you learn that you don’t qualify for Medicaid, you may be able to buy a private health plan sold in the health insurance marketplace. Many uninsured people who aren’t eligible for Medicaid can get help purchasing a plan in the marketplace, depending on their income and whether they already have the option of getting health insurance through work.

Unfortunately, in states that didn’t broaden access to Medicaid, many low-income people won’t qualify for it. And many of those with incomes below the poverty level will learn that they can’t get help paying for private insurance in the health insurance marketplace either. If this happens to you and your income later goes up (above the poverty level), you should check with the marketplace right away to find out if you qualify for help buying private insurance and ask when you can apply again through the marketplace. If your income drops or your situation changes, you can re-apply for Medicaid at any time.

You can find your state’s marketplace at www.healthcare.gov or www.CuidadoDeSalud.gov, or by phone at 1-800-318-2596. You can also contact your state Medicaid department to find out if you are eligible (see below, “Where can I get help?). To apply, you’ll need to provide basic information, including your social security number, household size, and estimated income.

Where can I get help?

Information is available in several languages online through www.healthcare.gov and www.GetCoveredAmerica.org. You can also learn more through the Health Insurance Marketplace toll-free call center at 1-800-318-2596 or TTY 1-855-889-4325 – both of which are available 24 hours a day, 7 days a week.

You can use the website https://localhelp.healthcare.gov to find people in your community who can help you apply, enroll, or give you answers to questions you might have about health insurance.

You can call 1-877-696-6775 to get contact information for your state health department, which runs your state Medicaid program. Or you can visit www.medicaid.gov/index.html.

No matter who you are, we can help. Contact your American Cancer Society anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

Last Medical Review: 11/13/2014
Last Revised: 11/14/2014