Medicaid · Step 1 of 3
How to apply for Medicaid: free or low-cost health coverage through your state
Why do Medicaid applications stall?Free · no sign-up · next page
Many Medicaid applications stall over small gaps
Medicaid is health coverage for people with low income. Each state runs its own program, and the federal government shares the cost and sets the basic rules. Every state must cover some groups, such as low-income families, pregnant women and children, and people who get SSI. Most states also cover adults under 65 based on income alone. Income limits, covered groups and benefits can differ from one state to the next.
You can apply for Medicaid at any time of the year. There is no open enrollment season. If you are eligible, coverage can start right away. Medicaid may also help pay for care you got in the months before you applied. Applications often slow down for simple reasons. A paper is missing. A letter from the state goes unanswered. Or the person applies in the wrong place. The next page shows the steps and what to have ready.
Questions most people have before they apply
How the Medicaid process works from start to finish
There are two ways in. You can apply straight to your state Medicaid agency. Or you can fill out one application through the Health Insurance Marketplace. If it looks like someone in your home qualifies, the Marketplace sends the details to your state, and the state contacts you about enrollment. Either way, only the state decides.
The state looks at your income, the size of your household, where you live and your citizenship or immigration status. It may ask for papers to prove what you wrote. It must give every applicant a decision within a set time. Then it sends a written notice. A notice that says no must explain your right to a fair hearing and how to ask for one. The next page explains each step and the papers to gather.
- Medicaid.gov, Eligibility Policy — Mandatory groups, MAGI income rules, citizenship and residency, effective date and 3-month retroactive coverage, medically needy spenddown in 36 states and D.C., fair hearings
- HealthCare.gov, Medicaid & CHIP coverage — Who Medicaid covers, the immigration status change, help with bills from the last 3 months, apply any time of year, two ways to apply
- HealthCare.gov, The Children's Health Insurance Program (CHIP) — Who CHIP is for, apply any time, coverage can start right away, 1-800-318-2596 (TTY 1-855-889-4325), what CHIP covers
- eCFR, 42 CFR 435.912, Timely determination of eligibility — Decision within 90 days for disability-based applications and 45 days for all others
- eCFR, 42 CFR 431.206, Informing applicants and beneficiaries — Right to a fair hearing and to bring a lawyer, relative, friend or other spokesperson