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This paper illustrates the considerable variation among states in Medicaid eligibility standards for the aged, blind, and disabled. Even within a single state, several income and resource standards may apply to these populations. In addition to Medicaids administrative structure and piecemeal evolution, variations are due to states choices regarding available coverage options. Many states do not take advantage of the broadest options. Financial and political considerations may limit states choices. Federal rules may also limit state flexibility to expand or simplify coverage in some areas, particularly medically needy programs. Still, the existing options are powerful tools available to states that want to expand or simplify coverage for the aged, blind, and disabled. The authors recommend that the federal government reconsider the link between medically needy income levels and states AFDC payment levels.