Eligibility
Medicaid covers people who would otherwise face considerable financial barriers to health care. Generally, a person must fall into a specific population group, referred to as categorical eligibility, and meet income thresholds in order to be eligible for Medicaid. Federal law mandates some of these eligibility groups; some are covered at state option. All states offer Medicaid coverage for low-income children, their parents, expectant mothers, seniors, and people with disabilities; some states have opted to expand eligibility further. To receive a full range of Medicaid benefits, individuals also must be U.S. citizens or qualified aliens. Learn more about eligibility pathways, eligibility and enrollment processes, and issues pertaining to specific populations.
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Featured Publications
Panel: Multi-Year Continuous Eligibility for Children
October 31, 2024
During this session, an expert panel discussed policies and considerations for state Medicaid and the State Children’s Health Insurance Program (CHIP) multi-year continuous eligibility (CE) approaches, which are designed to mitigate churn. Churn occurs when individuals disenroll and re-enroll in health coverage within a short period of time, leading to disruptions in coverage. With the […]
Highlights from MACStats 2023
December 14, 2023
The MACStats: Medicaid and CHIP Data Book compiles the most current data available on Medicaid and the State Children’s Health Insurance Program (CHIP) into a single, end-of-year publication. The data book contains statistics on Medicaid and CHIP enrollment and spending and key aspects of both programs, including federal matching rates, eligibility levels, and access to care measures, […]
Increasing the Rate of Ex Parte Renewals
September 26, 2023
To renew beneficiaries’ Medicaid coverage, states must first attempt to confirm ongoing eligibility using data available to the agency without requiring information from the individual. This requirement, also known as ex parte renewals, can reduce the administrative burden for states and simplify the process for beneficiaries. Improving ex parte rates has drawn renewed interest as […]
