long term consequences

The last thing that I think I understand about medicaid is that each state has the ability to dictate how the medicaid program would work. Does that mean that medicaid could vary from state to state? These programs are hard for me to understand and the the qualification are difficult to navigate. I know That I needed an expert to help me decide what to do but I just didn't feel like I had anyone that could explain to me all the options and the possible long term consequences. The social worker was pushing for a decision, any decision. And she wanted it soon.