Medicaid is a joint federal and state public assistance program for financing health care for low-income people. It pays for health care services for those with low incomes or very high medical bills relative to income and assets. It is the largest public payer of long-term care services.

There are many pathways to being eligible for Medicaid. For example, most states provide Medicaid to anyone who is receiving benefits under the Supplemental Security Income (SSI) program. A number of states provide Medicaid to older adults or persons with a disability who have an income that is below 100 percent of the federal poverty level ($1,063 a month for an individual in 2020).

For the most part, to be eligible for Medicaid you must be one of the following:

• Be age 65 or older

• Have a permanent disability as that term is defined by the Social Security Administration

• Be blind

• Be a pregnant woman

• Be a child, or the parent or caretaker of a child

In addition, you must meet certain other requirements, such as:

• Be a U.S. citizen or meet certain immigration rules

• Be a resident of the state where you apply

• Have a Social Security number

Am I eligible for Medicaid?

Check with your state’s Medicaid office to see if you or your family members are eligible for benefits. In general, it depends on at least one or a combination of:

• Age

• Income level

• Number of people in your family

• If you are pregnant or have a disability

How do I apply for Medicaid?

There are two ways to apply for Medicaid:

• Contact your state Medicaid agency. You must be a resident of the state where you are applying for benefits.

• Fill out an application through the Health Insurance Marketplace.

Children’s Health Insurance Program (CHIP)

If your income is too high for Medicaid, your child may still qualify for the Children’s Health Insurance Program (CHIP). It covers medical and dental care for uninsured children and teens up to age 19.

To be eligible for CHIP, the child's family must have an income that is:

• Too high to qualify for Medicaid

• Too low to afford private coverage

Medicaid and CHIP program names are different in each state.

Is my child eligible for CHIP?

CHIP qualifications are different in every state. In most cases, they depend on income.

How do I apply for CHIP benefits?

You have two ways to apply for CHIP:

• Contact your state’s program or call the Health Insurance Marketplace at 1-800-318-2596.

• Fill out an application through the Health Insurance Marketplace.

What else do I need to know about CHIP?

• You can apply for and enroll in Medicaid or CHIP anytime during the year.

• Like Medicare and CHIP, the Basic Health Program (BHP) offers affordable, continued coverage. It's available to people with incomes that shift above and below Medicaid or CHIP levels.

• Get information on other types of health insurance, such as Medicare, and find help paying for medical bills.

Long-Term Care Medicaid Services

Long-term care Medicaid services include medical and non-medical care for people with a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care services assist people with activities of daily living, such as dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, or in a facility.

For purposes of Medicaid eligibility and payment, long-term care services are those provided to an individual who requires a level of care equivalent to that received in a nursing facility.

In Maine, Medicaid is known as MaineCare and it provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. MaineCare is funded jointly by the state and federal government. To qualify for MaineCare, individuals must meet certain criteria such as age, income level, family size, and disability status. Specifically, eligibility may include those who are 65 or older, have a permanent disability as defined by the Social Security Administration, are blind, pregnant, a child, or the parent or caretaker of a child. Applicants must also be U.S. citizens or meet certain immigration requirements, be residents of Maine, and have a Social Security number. Income limits for eligibility are based on a percentage of the federal poverty level and can vary based on the number of people in the family and whether the applicant is pregnant or has a disability. Applications for MaineCare can be submitted through the state Medicaid agency or the Health Insurance Marketplace. Additionally, the Children’s Health Insurance Program (CHIP), known as Cub Care in Maine, provides coverage for uninsured children and teens up to age 19 whose families have incomes too high for MaineCare but too low to afford private coverage. Eligibility for Cub Care is based on the family's income and the program can be applied for at any time during the year, either through the state program or the Health Insurance Marketplace. Long-term care services under MaineCare are available for individuals who require a level of care equivalent to that received in a nursing facility, and these services can be provided in various settings including at home, in the community, or in a facility.