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Various health insurance options exist on the market, but what if you can not afford to pay monthly premiums? People making a significantly low income might be eligible for government help with Medicaid or Children’s Medicaid, also known as the Children’s Health Insurance Program (CHIP). The federal government works with each state’s government to administer these programs as insurance assistance for low-income individuals.
Who is eligible?
According to the Centers for Medicare and Medicaid Services, people eligible for Medicaid must fall within their state’s definition of low-income or very low-income. Generally, most states also require an applicant to be one of the following: pregnant or responsible for a child 18 or younger, blind, or have a disability, or have a family member in their household with a disability, be 65 or older. Some states have expanded their coverage to include all low-income adults. You can visit the Medicaid website to see your state’s qualifications.
Those who want to enroll in CHIP must also be 18 or younger to qualify for coverage. Additionally, CHIP applicants must be uninsured. They cannot have health coverage from group health plans or other creditable health insurance. A child must also have been determined ineligible for Medicaid.
What services do Medicaid insurance and CHIP cover?
Each state determines Medicaid costs and coverage options while adhering to federal regulations. Let’s look at one state’s covered services similar to many other states. In Texas, Medicaid and CHIP cover regular checkups at the doctor and dentist, medicines, vaccines, hospital care, vision care, hearing care, X-rays, lab tests, access to mental health care, access to medical specialists, treatment for pre-existing conditions, and treatment for special health needs. Also, in Texas, children with disabilities may receive long-term services through Medicaid. Some examples of these services include home care and personal care, a caregiver to help monitor your child’s health and assist the child with daily activities, a caregiver to take the child to medical appointments, nursing home care, a hospital for mental illnesses, a place of care for those with intellectual disabilities.
What is Medicaid unwinding?
Due to the 2020 pandemic, Congress approved continuous Medicaid and CHIP coverage for those already enrolled in these insurance assistance programs. States were required to follow this law to continue to receive federal funds for Medicaid and CHIP. Once the public health emergency ended on March 31, 2023, states began unwinding– disenrolling ineligible applicants. The unwinding affected many people. More than 20 million people lost Medicaid and CHIP coverage during this post-pandemic process.
How can I get insurance coverage after I lost my Medicaid or CHIP?
Did you lose your coverage during the recent Medicaid unwinding? You can reapply for Medicaid or CHIP at any time of the year. Empower Brokerage’s friendly licensed agents can assist you in reapplying to these programs. Have you already found you are ineligible for Medicaid or CHIP coverage? Empower Brokerage’s agents can help you find the right Marketplace insurance to fit your specific needs and circumstances. Call us at (844) 410-1320 to speak with one of our agents today.
If you found this article beneficial, please read about disability insurance.
2026 Update by Parker Williamson
Understanding Medicaid: Who Qualifies and What It Covers
Health insurance can be expensive, but if you have a limited income, Medicaid could provide free or inexpensive health coverage. Medicaid is a government-funded health insurance program that helps eligible individuals and families access essential healthcare services.
While Medicaid is funded jointly by the federal and state governments, each state administers its own program. Because of this, eligibility requirements, covered services, and benefits may vary depending on where you live.
Who Qualifies for Medicaid?
Medicaid provides health coverage for eligible individuals and families. Eligibility is determined by each state and is based on factors such as income, household size, age, pregnancy, disability, and other state-specific requirements.
Depending on your state, you may qualify if you are:
- Certain low-income adults
- Pregnant
- A child or teenager
- A parent or caregiver of a dependent child
- Age 65 or older
- Blind or living with a qualifying disability
If your child does not qualify for Medicaid, they may be eligible for the Children’s Health Insurance Program (CHIP), which provides low-cost health coverage for children in families who meet their state’s eligibility requirements.
You can apply for Medicaid through your state’s Medicaid agency or, in many states, through the Health Insurance Marketplace.
What Does Medicaid Cover?
Although coverage varies by state, Medicaid generally covers a wide range of medically necessary health care services, including:
- Primary care and preventive services
- Doctor visits
- Hospital and emergency care
- Prescription medications
- Laboratory tests and X-rays
- Maternity and prenatal care
- Mental health and behavioral health services
- Pediatric care
- Vaccinations
When Can You Apply for Medicaid?
Unlike many private health insurance plans, Medicaid enrollment is available year-round. If you believe you may qualify, you can apply at any time. If your income or household situation changes, you may become eligible even if you were previously denied coverage.
What If You Don’t Qualify for Medicaid?
If you are not eligible for Medicaid, you may still have affordable health insurance options through the Affordable Care Act (ACA) Marketplace. Depending on your household income, you may be eligible for financial assistance that can help reduce your monthly premium and out-of-pocket costs.
Have Health Insurance Questions?
We hope that this information on Medicaid insurance is helpful for you.
Insurance is oftentimes overwhelming, and we want to shed light on the industry by answering your questions. Comment below and your question may be the topic of our next post!
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This article was updated on July 2, 2026.