Medicaid drug coverage is not one size fits all—and 2025–2026 brings some of the biggest shifts in years. Below, we break down the federal rules now in force, how states are handling GLP-1 weight-loss drugs and sickle cell gene therapies, and where to click to confirm your state’s latest PDL. What changed federally for 2025–2026? … Read more
In 2025, the Affordable Care Act (ACA) still shapes Medicaid in two big ways that seniors feel indirectly: (1) which states expanded Medicaid (affecting local delivery systems and budgets), and (2) how states process applications/renewals (streamlined rules and timelines that also touch seniors). But core senior eligibility (SSI-based) remains largely outside ACA’s MAGI rules. KFF+2Medicaid+2 … Read more
In 2025, California remains the only state that has fully suspended (eliminated) the Medicaid asset test—for Medi-Cal non-MAGI programs—while other states are raising limits or considering a phase-out. Below is the plain-English rundown of what’s in effect now and what’s proposed next, with official sources. Quick answer: Which states suspended Medicaid asset tests in 2025? … Read more
Medicaid covers over 70 million Americans, but what it covers for adults depends heavily on the state you live in. In 2025, the biggest differences show up in adult dental/vision, postpartum coverage, behavioral health, long-term care at home, and expansion to low-income adults. Below is a plain-English, state-by-state guide with trusted sources. Quick answer: What … Read more
Medicare got pricier in 2025—and early 2026 projections point to another bump. The good news: Medicaid programs (QMB/SLMB/QI) and Extra Help can cover your Part B premium and most drug costs, and a new $2,000 Part D cap plus a monthly payment option can tame pharmacy shocks. Here’s exactly what changed and how to cushion … Read more
Several high-impact COVID-era benefits end in 2025. The big dates: Sept 30, 2025 (Medicare telehealth + Hospital at Home) and Dec 31, 2025 (ACA enhanced subsidies and DEA tele-prescribing). Here’s what’s expiring, who’s affected, and what to do now—with exact deadlines and prep checklists. KFF+3telehealth.hhs.gov+3American Hospital Association+3 What’s ending in 2025? (Quick answer) Bottom line: … Read more
Short version: No state newly adopted Medicaid expansion in 2025. The national count remains 41 states (including DC) expanded, 10 not. But 2025 still brought policy shifts, updated FPL numbers, and growing pressure in several holdouts. Below: the current map, what changed, and how to prepare. KFF Quick answer—any new expansion states in 2025? No. … Read more
Short answer: Working does not automatically end Medicaid. Many disabled adults can keep coverage through SSI-linked Medicaid (1619(b)), Medicaid Buy-In, MAGI pathways, medically needy spenddown, or HCBS rules that allow income up to 300% of SSI. The right door depends on your program and state. Social SecurityMedicaid+2Medicaid+2KFF Does work make you lose Medicaid? (the quick … Read more
Short answer: Millions of older Americans qualify for help but aren’t getting it. Data show low enrollment in SNAP, SSI, and Medicare Savings Programs; long waits for home care; and big holes in Medicare (dental, hearing, routine vision, long-term custodial care). Below is what the numbers say — and how to fix it today. National … Read more
Here’s the short answer: Children on Medicaid get vision, hearing, and dental nationwide under EPSDT. For adults, coverage exists in most states—but what’s included (exams, eyeglasses, hearing aids, crowns, dentures, etc.) varies by state and plan. Use the quick-lookup below and the 2-minute verification steps to confirm your benefits today. (EPSDT: Medicaid.gov.) Medicaid What Medicaid … Read more