Before January 2014 state Medicaid programs were required to cover poor pregnant women and children, and the FPL cutoffs varied by group. States had the option of providing increased coverage within these groups, and to expand coverage to other people. As previously explained Medicaid expansion will cover all persons up to 133% of the FPL in states choosing to expand. If states do not expand, coverage will vary by FPL within a group. Pregnant women, children, the elderly and the disabled have minimum coverage thresholds. Many states have minimal or no coverage for adults, especially for adults without children.

Financing and Reimbursement

Medicaid is jointly funded by the US Federal Government and the individual States. The federal government pays states for a specified percentage of program expenditures (the FMAP). More information is available on the Financing and Reimbursement web page at

 Children's Health Insurance Program (CHIP)

The Children's Health Insurance Program (CHIP) provides health coverage to nearly 8 million children in families with incomes too high to qualify for Medicaid, who can't afford private coverage. Signed into law in 1997, CHIP provides federal matching funds to states to provide this coverage. See additional information on Cost Sharing.

If you would like more information about Medicaid, check these three sites:


Comparison of Medicare and Medicaid



  • Covers all elderly (as originally designed) and the permanently disabled.
  • No income/means test
  • Need Parts A, B and D or Parts C and D to have full coverage.
  • Nationally uniform program
  • Part A financed through payroll taxes
  • Parts B and D subsidized through general taxes, but the participants pay part of the premium cost
  • Will cover all those up to 133% of the FPL if the state accepts the ACA Medicaid expansion. Covers the existing categories of poor persons  (children, pregnant women, some disabled) in all states.
  • States may choose to increase coverage beyond the federal minimums
  • Public welfare
  • All services are covered under one program
  • Program varies from state to state beyond the essential benefits
  • Financed by the states with matching funds from the federal government according to each state's per capita income. Full federal coverage for newly enrolled under Medicaid expansion.

Dual Eligibles

Dual eligible refers to patients with both Medicare and Medicaid. The care of dual eligibles is often expensive, fragmented, and of varying quality.  Innovative models of care for duals (often consider duals < 65 years separately from elderly duals) are needed to provide efficient and effective care for these vulnerable populations. 

Dual Eligibles


Infographic: Medicaid Spending and Enrollment: Who Is Covered and What Does the Program Spend on Their Care

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Medicaid Information by Topic from


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More Resources



Medicaid 101: What You Need to Know

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