How to Apply for Medicaid

Who qualifies

Medicaid eligibility is a function of three things: where you live, what your household looks like, and what category you fall into. The basic categories are:

Children. Every state covers children below a relatively high income threshold — typically 200% or higher of the federal poverty level. CHIP (the Children's Health Insurance Program) covers children whose families earn slightly too much for Medicaid. Together, Medicaid and CHIP cover most low- and moderate-income children in the U.S.

Pregnant people. Coverage is broad in every state, with income thresholds often higher than for other adults. Pregnancy-related Medicaid covers prenatal care, delivery, and a postpartum period.

Adults under 65. This is where state-by-state differences matter most. States that expanded Medicaid under the Affordable Care Act (more than 40 states plus DC as of 2026) cover adults up to 138% of the federal poverty level — about $20,000/year for a single person. States that didn't expand have much narrower eligibility, usually limited to parents of dependent children at very low income.

Aged, blind, and disabled. People over 65 or with qualifying disabilities have separate pathways, often connected to SSI (Supplemental Security Income).

Special categories. Foster youth, breast and cervical cancer patients, some former inmates, and certain other groups have specific eligibility.

To check eligibility quickly, use the HealthCare.gov screener. It takes a few minutes and tells you whether you likely qualify in your state.

How to apply

There are three main paths to apply:

Through HealthCare.gov. Apply at HealthCare.gov or call 1-800-318-2596. If you're potentially Medicaid-eligible, the system will route your application to your state agency. This is the easiest way if you're not sure whether you qualify for Medicaid or for an ACA Marketplace plan.

Through your state Medicaid agency. Every state has its own Medicaid application portal. This is often the better path if you're confident you'll qualify, since state portals tend to handle state-specific questions more cleanly. Search "[your state] Medicaid apply" to find it.

In person. Many county social services offices, FQHCs, and hospitals have enrollment counselors who can sit with you and walk through the application. They know your state's quirks. Ask any clinic or health center if they have one.

What you'll need

The application typically asks for:

• Names, dates of birth, and Social Security Numbers for everyone in your household
• Citizenship or immigration status documents (see below)
• Income proof — pay stubs, tax returns, unemployment letters
• Employer information if anyone in the household has insurance available through work
• Resource information in some states for certain categories (less common after the ACA simplified rules)
• Pregnancy verification if applicable

If you don't have everything immediately, start the application anyway. States must give you a reasonable opportunity to provide documents after submission.

A note on immigration status

This is a sensitive area. The basic rules:

• U.S. citizens qualify based on the other criteria above.
• Lawful permanent residents (green card holders) generally qualify after a 5-year waiting period, though some states cover children and pregnant people without the waiting period.
• Refugees, asylees, and certain humanitarian categories generally qualify immediately.
• Undocumented immigrants are not eligible for federal Medicaid (with the exception of emergency Medicaid, which covers emergency care regardless of immigration status).

Applying for Medicaid does not, by itself, affect immigration status or trigger a "public charge" review for most categories. For specific situations, talk to a free immigration legal aid organization. The Protecting Immigrant Families coalition has up-to-date guidance.

How long it takes

Federal rules require states to process Medicaid applications within:

• 45 days for most categories
• 90 days for disability-related applications
• Faster for pregnancy and emergency situations

Coverage can start the month you apply, and many states offer retroactive coverage up to 3 months before the application — which means if you have medical bills from the recent past, those bills may be covered if you qualify. Always ask about retroactive eligibility.

If you're denied

Denials are common and frequently reversed on appeal. If you receive a denial letter:

1. Read it carefully. It will state the reason — income too high, missing documents, ineligible category. Often the reason is fixable.
2. Ask for an appeal. Every state has a Medicaid appeal process and a deadline (usually 30–90 days from the denial letter). You have the right to a hearing.
3. Get help. Free legal aid organizations handle Medicaid appeals all the time. Search LawHelp.org by state. State ombudsman offices can also intervene.
4. Check for category errors. Sometimes the state has applied the wrong category — for example, processing you as a parent when you have a disability that would qualify you in a different pathway with different rules.

After enrollment

Once you're on Medicaid:

• You'll get a Medicaid ID card. Bring it to every appointment.
• You can choose a managed care plan in many states. Pick one whose network includes the providers you want to see.
• You must report changes — income, household size, address — typically within 10 days.
• You'll have an annual renewal, often automated, but watch your mail. People sometimes lose coverage simply because they missed the renewal notice.

Medicaid versus other programs

Quick clarification of related programs:

• Medicaid — income-based, jointly federal and state, free or very low cost
• CHIP — Children's Health Insurance Program, for kids in families earning too much for Medicaid
• Medicare — age- or disability-based, federal, has premiums and copays. Some people have both Medicare and Medicaid ("dual-eligible") and Medicaid picks up Medicare's out-of-pocket costs.
• ACA Marketplace plans — for people earning too much for Medicaid; subsidies can make them affordable.

While you wait

Don't put off care because your application is pending. FQHCs and free clinics will see you regardless of Medicaid status, on the same sliding scale. Many providers will hold a bill while a Medicaid application is processing, then bill Medicaid retroactively if you're approved. Always ask up front.

Help with the application

Free assistance is available:

• HealthCare.gov assisters — find a navigator at localhelp.healthcare.gov
• FQHCs — most have on-site enrollment counselors
• Hospital social workers — many will help patients enroll, especially in connection with care
• Legal aid organizations — for complex cases, denials, and appeals

You're not on your own with this paperwork. Many people who would qualify never apply because the process feels overwhelming. Start the application, get help where you need it, and don't be discouraged by a first denial.