Medicaid is a federal entitlement health insurance program; both the federal and state government pay for the Medicaid program.  Beneficiaries must apply for Medicaid and prove that they are eligible, based on their income (financially eligible) and situation (category eligible).  Medicaid pays for certain health services for low-income children and their parents or caretaker relatives who have custody of them; low-income people with disabilities and low-income adults age 65 and older.  Medicaid also pays for nursing home care for qualified low-income adults.  (For more information on Medicaid eligibility, see the Screening for Medicaid and State Children's Health Insurance Program (SCHIP) Eligibility Manual.)

Consumer health assistance programs to serve Medicaid consumers exist in numerous states. They help people get and keep Medicaid benefits and they help Medicaid beneficiaries get the care they need. They counsel individuals; educate patients and health care providers; and collect data about consumers’ concerns in order to assist policymakers, Medicaid agencies, and health plans.  Program staff may have a variety of roles in counseling Medicaid beneficiaries, ranging from coaching consumers to investigating complaints to mediating solutions to actually representing consumers in grievances and fair hearings. People who are eligible for both Medicare and Medicaid may also contact their state SHIP (State Health Insurance Assistance Program) which specialized in helping people understand Medicare.

Residents of nursing homes, board and care homes, and assisted living facilities can contact a long-term care ombudsman program located in every state, the District of Columbia, Guam, Puerto Rico, and Virgin Islands.

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