

"A lot of people have perceptions about who is eligible and who is not that aren't quite right," says Cindy Mann, director of the federal Center for Medicaid. "It's a much broader program than people think."

Medicaid, the state and federally run health-insurance program for the poor, is getting a rehab under the Affordable Care Act, with some changes phasing in now. For many people who qualify that means free health care.

Historically, difficulty with enrollment and lack of awareness of eligibility have been barriers to the program, says Samantha Artiga, associate director of the Kaiser Family Foundation, a health-policy nonprofit. Many low-income adults tend not to qualify, as the programs are typically restricted to children, parents, pregnant women, and older, blind and disabled people.

That's all set to change in 2014, when Medicaid becomes one of the health overhaul's main vehicles for insurance coverage expansion. Individuals making up to 133% of the poverty level, or about $14,494 per year, or a family of three that earns some $24,645 a year, can qualify.

But if the Supreme Court strikes down the law as unconstitutional, according to Kaiser, the roughly 16 million low-income adults that the Medicaid expansion would help would likely remain uninsured. Federal funds for the states to expand would presumably not be available.

Some changes are already happening, and you can take advantage of those now. At least seven states are acting early and have begun expanding Medicaid to the 2014 levels for adults. These are Colorado, California, Connecticut, Minnesota, New Jersey, Washington state and Washington, D.C., according to Kaiser.

Over the past several years, many states also have increased their eligibility levels for children, says Ms. Mann. Some states now have a simplified two-page application to get kids enrolled.

One of the main difficulties with Medicaid has been that eligibility varies across state lines. Now states are starting to streamline their application processes, says Ms. Mann. States including Utah, Georgia, Wisconsin and Michigan have moved the process online. Some of these systems can also cross check other state databases, which makes it easier to renew enrollees each year. This will become standard in 2014, but some states are already there so it pays to check if your state is one of them.

The government also is raising payment rates so your doctors might be more willing to accept Medicaid. Starting next year, Ms. Mann says Medicaid is increasing reimbursement rates for primary-care providers.

There are a few resources that can help you get started. The federal government website HealthCare.gov can direct you to your state Medicaid office. At InsureKidsNow.gov you can find out what your state offers. The Kaiser Family Foundation's statehealthfacts.org explains each state's eligibility levels.

Consider calling a patient advocate to discuss the specifics of your situation. Disease-specific organizations also are a resource if you think you might be eligible for Medicaid but have questions, says Erin Moaratty, chief of mission delivery at the Patient Advocate Foundation, a nonprofit that helps patients get access to care.

Another tip: If you're in the hospital, take advantage of social workers' know how. They are often experts on your state's Medicaid application process, and can help you navigate local bureaucracies, says Ms. Moaratty.

"Even when you are in doubt, I always encourage an application to the local department of social services," she says. "People have a hard time accepting that there is a program out there that can help them. It's pride."