Being poor in the United States means being exposed to the Medicaid system, whose characteristics, as determined by both federal and state policy, affect access to health care. This paper examines those aspects of the Medicaid system which have a disparate impact on women because they are overrepresented in certain social strata, as well as some aspects which affect the ability of both sexes to utilize the health care system. Owing to the problems of women in society, women make up two-thirds of the Medicaid clientele. Thus the burdens created by the limitations of Medicaid are a significant gender issue. Policies regarding AFDC coverage and pregnancy particularly concern younger women, many of whom have problems related to marriage, childbirth, and absence of economic support from fathers which place them at risk for poverty. Regulations as to income and assets of elderly persons requiring long-term care are among the policies that affect older women whose spouses have become disabled. Mandating less restrictive eligibility standards and coverage during transition of Medicaid clients to work would help address the twin problems of inferiority and uncertainty with regard to health care.