Medicaid is not only for seniors. In fact, seniors make up just 10% of all Medicaid enrollees. The vast majority of people covered by Medicaid are non-elderly adults and children. This is one of the most common points of confusion in American health care, largely because people mix up Medicaid with Medicare, which is the program primarily designed for people 65 and older.
Who Medicaid Actually Covers
Medicaid is a joint federal and state program that helps cover medical costs for people with limited income and resources. Federal law requires every state to cover certain groups: low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI), which includes people with disabilities.
Looking at the actual numbers tells the story clearly. According to 2023 enrollment data from KFF, 54% of all Medicaid enrollees are non-elderly adults between 19 and 64. Another 36% are children age 18 and under. Seniors 65 and older account for roughly 10% of enrollment. So nine out of every ten people on Medicaid are not seniors.
Medicaid vs. Medicare
The confusion usually comes from mixing up two programs with similar names. Medicare is federal health insurance for people 65 or older (and some younger people with certain disabilities). It’s funded through payroll taxes and congressional appropriations, and eligibility is based primarily on age and work history, not income.
Medicaid works differently. It’s based on income and need, not age. It’s jointly funded by federal and state governments, and each state runs its own version of the program within federal guidelines. Some seniors qualify for both programs simultaneously, which adds to the confusion, but the two programs serve fundamentally different purposes.
Low-Income Adults Under 65
The Affordable Care Act of 2010 gave states the option to expand Medicaid to cover nearly all low-income Americans under age 65. In states that adopted this expansion, any adult aged 18 to 65 with a household income at or below 138% of the federal poverty level can qualify, regardless of family status or health condition. That threshold works out to roughly $20,800 per year for a single person in 2025.
Before the ACA, many states only covered adults if they had dependent children, were pregnant, or had a disability. Expansion changed that by opening the door to single adults and childless couples who simply had low incomes. Most states have now adopted expansion, though a handful still use the older, more restrictive rules.
Children and Pregnant Women
Children are one of the largest groups Medicaid serves. Federal law requires states to cover children in families with incomes up to at least 133% of the federal poverty level, and most states set their cutoff even higher. Young adults who aged out of foster care also qualify at any income level.
For families whose income is too high for Medicaid but too low to afford private insurance, the Children’s Health Insurance Program (CHIP) fills the gap. CHIP covers uninsured children under 19 and, in some states, pregnant women. Children must be U.S. citizens or meet immigration requirements, and they can’t already be covered through a parent’s employer plan. States are prohibited from denying CHIP eligibility based on a child’s diagnosis.
Pregnant women have their own eligibility pathway. Medicaid covers prenatal care, delivery, and postpartum services, and many states extend coverage to pregnant women at higher income levels than they use for other adults. Mandatory benefits for this group include nurse midwife services, freestanding birth center services, and tobacco cessation counseling during pregnancy.
People With Disabilities
Disability is a major pathway into Medicaid for people of any age. In 35 states and the District of Columbia, qualifying for SSI benefits automatically makes you eligible for Medicaid. In those states, the SSI application doubles as your Medicaid application, and coverage starts the same month. Other states require a separate Medicaid application or use their own eligibility rules that differ from the federal SSI criteria. Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Oklahoma, and Virginia all fall into that category.
For people with disabilities who want to work, Medicaid has provisions that allow continued coverage even after you start earning income. To keep your benefits, you generally need to still meet the disability criteria, need Medicaid in order to work, and earn less than what it would take to replace your SSI, Medicaid, and any publicly funded attendant care combined.
What Medicaid Covers
Regardless of which eligibility group you fall into, Medicaid provides a broad set of mandatory benefits. These include inpatient and outpatient hospital visits, physician services, lab work and X-rays, home health services, family planning, and transportation to medical appointments. States can also offer optional benefits on top of these, which is why coverage varies somewhat from state to state.
Children get an especially comprehensive package through a benefit called Early and Periodic Screening, Diagnostic, and Treatment services. This requires states to provide regular health screenings for kids and cover any treatment needed to address conditions found during those screenings, even if the treatment wouldn’t normally be covered under the state’s plan. Medicaid also covers concurrent hospice care for children, meaning kids receiving hospice services can continue getting curative treatment at the same time.
One benefit that’s easy to overlook is medication-assisted treatment for substance use disorders, which is now a mandatory Medicaid benefit. This covers medications used to treat opioid and alcohol dependence along with counseling and behavioral therapy.
How to Know If You Qualify
Your eligibility depends on your state, your household income, your age, and whether you have a disability or are pregnant. In expansion states, the simplest test is income: if you’re under 65 and your household earns less than 138% of the federal poverty level, you likely qualify. In non-expansion states, you typically need to fall into a specific category like being a parent of dependent children, being pregnant, or having a qualifying disability.
You can check your eligibility through your state’s Medicaid agency or through HealthCare.gov. When you apply for coverage on the federal marketplace, the system will automatically determine whether you qualify for Medicaid based on the income and household information you provide. If you do, your application gets routed to your state’s Medicaid program.