What this is
Medicaid is a joint federal-state program that pays for medical care for millions of low-income people, including children, parents, pregnant people, seniors, and people with disabilities. Every state runs its own program name, rules, and application process within federal minimum standards.
Advocates often meet Medicaid when a service is denied, coverage ends, or a renewal form was missed—not at enrollment. This guide orients you to how the program works before you open a specific delivery model guide.
State and federal roles
The federal government sets broad rules and pays a large share of costs. Each state Medicaid agency decides eligibility categories, benefits beyond federal floors, payment rates, and whether to use managed care. CMS oversees state compliance.
That split means advocates must know which state the patient is in and whether an MCO card or state ID is primary on the denial letter.
Who qualifies
Categories include children (CHIP in many states), parents and caretakers, ACA expansion adults in many states, pregnant people, seniors and people with disabilities who meet financial rules, and long-term care recipients. Immigration status rules apply. Eligibility denials and renewals are a separate track from service denials—see Medicaid eligibility & renewals.
How benefits are delivered
Most states use managed care: a private plan administers benefits. See Medicaid managed care.
Some enrollees remain in fee-for-service (FFS) Medicaid where the state pays providers directly. See Medicaid fee-for-service.
State-specific agency links live under State Medicaid guides and State insurers & legislation on the Insurance topic.
Where to go next
Bottom line
Medicaid is state-run, federally funded, and often delivered through MCOs. Separate eligibility problems from service denials, identify managed care vs FFS, and use state fair hearing rights when plan appeals are not enough.