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What is Medicaid?

Medicaid is a federal and state program that provides health care coverage to people who qualify. Each state runs its own Medicaid program, but the federal government has rules that all states must follow. The federal government also provides at least half of the funding for their Medicaid requirements.

Based on federal regulations, states create and run their own Medicaid program to best serve its residents who qualify. States may choose to provide more services than the federal government requires and they may also choose to provide coverage to larger groups of people. Medicaid provides health care coverage for people who qualify, based on income and the value of what they own.

The history of Medicaid

Medicaid began as part of the Social Security Act of 1965. The original law gave states the option of receiving federal funding to help provide health care coverage to children whose families have a low income, their caregiver relatives, people who are blind and people who are disabled. Over time, the federal government has strengthened the rules and requirements for state Medicaid programs.

Each state decides the full range of benefits that it covers under Medicaid

Who does Medicaid serve?

Medicaid programs serve specific groups of people, including:

  • Pregnant women with low income
  • Children of low-income families
  • Children in foster care
  • People with disabilities
  • Seniors with low income
  • Parents or caregivers with low income

States can also choose to expand eligibility to other groups, such as people with low income who may or may not have children.

Learn about Medicaid plans

With Medicaid, there may be several types of low-cost or no-cost plans available, depending on the state where you live. Learn about the types of plans below.

Plan type What it covers

Medicaid

 Low-cost or no-cost health insurance coverage that is managed by each state. Eligibility requirements can change from state to state. Your state may even have its own name for its Medicaid program.

Dual Eligible Special Needs plans (D-SNP)

 Insurance coverage for people who qualify for both Medicare and Medicaid. Most dual plans give you more benefits than you get with Original Medicare.

Children's Health Insurance Program (CHIP)

 Low-cost or no-cost coverage for infants, children and teens. Designed to help children get the care they need as they develop.

76.4 million individuals enrolled in Medicaid and CHIP

69.7 million individuals enrolled in Medicaid

6.6 million individuals enrolled in CHIP

Source: Medicaid.gov August 2020 Enrollment Report

What care services are covered by Medicaid?

Each state decides the full range of benefits that it covers under Medicaid. Federal law requires that states must provide certain benefits, which are called mandatory benefits. States may also choose to offer other benefits and services by Medicaid. These are called optional benefits. The chart below shows what are mandatory benefits and what are optional Medicaid benefits.

Mandatory Medicaid benefits:
  • Inpatient hospital services
  • Outpatient hospital services
  • Early and periodic screening, diagnostic and treatment services (EPSDT)
  • Nursing facility services
  • Home health services
  • Physician services
  • Rural health clinic services
  • Federally qualified health center services
  • Laboratory and X-ray services
  • Family planning services
  • Nurse midwife services
  • Certified pediatric and family nurse practitioner services
  • Freestanding birth center services (when licensed or otherwise recognized by the state)
  • Transportation to medical care
  • Tobacco cessation counseling for pregnant women
Optional Medicaid benefits:
  • Prescription drugs
  • Clinic services
  • Physical therapy
  • Occupational therapy (thinking and movement)
  • Speech, hearing and language disorder services
  • Respiratory (breathing) care services
  • Other diagnostic, screening, preventive and rehabilitative services
  • Podiatry (foot care) services
  • Optometry (vision) services
  • Dental services
  • Dentures
  • Prosthetics (to replace missing or damaged body parts)
  • Eyeglasses
  • Chiropractic services
  • Other practitioner services
  • Private duty nursing services
  • Personal care
  • Hospice
  • Case management
  • Services for individuals age 65 or older in an institution for mental disease (IMD)
  • Services in an intermediate care facility for individuals with intellectual disability
  • Self-directed personal assistance services
  • Community first choice option
  • TB-related services
  • Inpatient psychiatric services for individuals under age 21
  • Other services approved by the Secretary of Health and Human Services
  • Health homes for enrollees with chronic conditions

This includes services furnished in a religious nonmedical health care institution, emergency hospital services by a non-Medicare certified hospital, and critical access hospital (CAH) Medicaid prescription drug coverage.1

Prescription drug coverage is an optional benefit under federal Medicaid law. But, as of 2020, all states include some form of prescription drug coverage under their Medicaid program. In general, most enrollees within a state Medicaid program will get prescription drug coverage.

Medicaid home health care and residential senior care coverage

Medicaid programs may also cover a variety of different Home- and Community-Based Services (HCBS) to help people stay living at home and active in their community. The level of support provided is typically based on the needs of the individual.

Examples of the types of home health care and residential senior care services provided as part of HBCS programs include:

  • Personal care, like showering
  • Transportation services
  • Skilled nursing care
  • Occupational, speech and physical therapy
  • Managing diet and nutrition (healthy eating)
  • Home-delivered meals
  • Home chores and housekeeping

Some HCBS services, like skilled nursing care and occupational, physical or speech therapy, are delivered by qualified and, in some cases, licensed professionals. Other services, such as doing chores around the house and making meals, can be provided by family members, friends or paid caregivers.

How to apply for Medicaid

Because each state manages its own Medicaid program, eligibility varies from one state to another. If you have questions about qualifying, contact your state Medicaid agency. Or, apply online at the website for your state Medicaid agency to see if you qualify.

Answer a few quick questions to see what type of plan may be a good fit for you.

Check plan eligibility

Medicaid or dual-eligible plan benefits can change depending on where you live. Search using your ZIP code to find the right plan to meet your health care needs.

1Benefits and features vary by plan/area. Limitations and exclusions apply.


Disclaimer information
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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Premium disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Benefit disclaimer

Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

Nurse Hotline disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your provider's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time. Nurse Hotline not for use in emergencies, for informational purposes only.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® (Medicare-Medicaid plan)

UnitedHealthcare Connected® (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® general benefit disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the member handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® member handbook. 

UnitedHealthcare Senior Care Options (HMO SNP) plan

UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health Insurance, except Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options (SCO) program.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2024.

Important provider information

The choice is yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 1-888-638-6613 / TTY 711, or use your preferred relay service.

Declaration of disaster or emergency

If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.