Medicaid serves low-income children, pregnant women, seniors, and people with disabilities, along with millions of working-age adults in states that have expanded the program. As of November 2025, about 76 million people were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) across all 50 states and Washington, D.C. That makes Medicaid the single largest health insurance program in the country.
Groups That Every State Must Cover
Federal law requires all states to provide Medicaid to certain populations regardless of where they live. These mandatory groups include:
- Children and teens under 19 in families with low incomes
- Pregnant women and newborns
- Parents and caretaker relatives with low incomes
- Seniors, people who are blind, and people with disabilities who receive Supplemental Security Income (SSI)
- Adults ages 19 to 64 with household income at or below 133% of the federal poverty level, in states that have expanded Medicaid
Income limits are tied to the federal poverty level, which for 2026 is $15,960 for an individual and $33,000 for a family of four. In expansion states, an individual earning roughly $21,300 or less (138% of the poverty level, after a standard income adjustment) can qualify.
Children and Families
Children make up the largest share of Medicaid enrollees by category. Medicaid covers more than half of all children in the country, and by age 18, roughly three in five U.S. children will have been enrolled in Medicaid or CHIP at some point. That includes kids whose families cycle in and out of eligibility as household income changes. States with the most restrictive income thresholds tend to see the highest rates of coverage gaps for children, meaning kids lose and regain coverage more often.
CHIP, which works alongside Medicaid, extends coverage to children in families that earn too much for traditional Medicaid but can’t afford private insurance. About 7.2 million children were enrolled in CHIP as of November 2025.
Pregnant Women and New Mothers
Medicaid pays for 41% of all births in the United States. Coverage for pregnant women has historically ended 60 days after delivery, but a growing number of states now extend that to a full 12 months postpartum. At least 30 states and Washington, D.C., have adopted the 12-month extension, giving an estimated 462,000 people longer access to care after giving birth. If every state adopted this option, roughly 720,000 people would gain extended postpartum coverage.
This matters because the months after delivery are a high-risk period for complications like postpartum depression, infections, and cardiovascular problems. Losing insurance at 60 days meant many new mothers skipped follow-up care entirely.
Seniors and People With Disabilities
About 12 million people are “dually eligible,” meaning they’re enrolled in both Medicare and Medicaid at the same time. That group includes 7.2 million low-income seniors and 4.8 million people with disabilities. Together, they make up more than 15% of all Medicaid enrollees.
For these individuals, Medicare handles the basics like hospital stays, doctor visits, and some prescription drug costs. Medicaid then fills the gaps. It can pay Medicare premiums and out-of-pocket costs, and it covers services Medicare doesn’t, including nursing home care beyond 100 days, eyeglasses, and hearing aids. When both programs cover a service, Medicare pays first and Medicaid covers the remaining amount up to the state’s limit.
In 35 states and Washington, D.C., qualifying for SSI automatically qualifies you for Medicaid with no separate application. Nine states use their own eligibility rules that differ from SSI standards, so residents in those states need to apply for Medicaid separately. Even if someone’s earnings eventually grow too high for an SSI cash payment, Medicaid coverage can continue as long as they still meet the disability criteria and need the coverage to keep working.
Long-Term Care Recipients
Medicaid is the primary payer for nursing home care in the United States. Many people enter a nursing facility paying out of pocket or through private insurance, then transition to Medicaid once they’ve exhausted their savings. If the nursing home is Medicaid-certified, the resident can stay under the Medicaid benefit.
Each state sets its own criteria for what counts as needing nursing facility-level care, but generally the person must require skilled nursing, rehabilitation, or ongoing health-related services that aren’t available in the community. People with serious mental illness or intellectual disabilities go through an additional screening to determine whether a nursing facility is the right setting or whether community-based services would be more appropriate. Some states apply higher income limits for people living in institutions than for those receiving care at home.
Adults in Expansion States
Before the Affordable Care Act, most states did not cover childless adults under Medicaid at all, regardless of how little they earned. The ACA gave states the option to extend Medicaid to all adults under 65 with incomes below 138% of the federal poverty level. Forty states and Washington, D.C., have taken that option. Ten states, mostly in the South, have not.
In non-expansion states, adults without children or a disability often fall into a “coverage gap.” They earn too little to qualify for subsidized insurance on the health insurance marketplace but don’t fit any of the traditional Medicaid categories. The federal government covers 90% of costs for the expansion population, compared to a lower matching rate for traditional Medicaid groups.
Citizenship and Residency Requirements
Medicaid requires that enrollees be U.S. citizens or qualified noncitizens and reside in the state where they’re applying. Most qualified noncitizens, including lawful permanent residents, face a five-year waiting period before they can enroll. That clock starts when they receive their qualifying immigration status, not when they first enter the country. Certain groups are exempt from the waiting period, including refugees, asylees, and lawful permanent residents who previously held refugee or asylee status.
Who Enrolls by the Numbers
Of the roughly 69 million people enrolled in Medicaid (not counting CHIP) as of late 2025, the demographic breakdown reflects the program’s focus on lower-income populations. White enrollees make up the largest single group at about 36%, followed by Hispanic enrollees at 24% and Black enrollees at 19%. Asian Americans account for about 4% of enrollment. These proportions vary significantly by state depending on local demographics and eligibility rules.
The program’s reach is broad. At any given time, roughly one in five Americans is covered by Medicaid or CHIP. For many, enrollment is temporary, lasting through a pregnancy, a period of job loss, or childhood. For others, particularly seniors in nursing facilities and people with lifelong disabilities, Medicaid is a permanent source of coverage that no other program replaces.