How to Apply for Medicaid

Medicaid is a program run by state and local governments under federal laws and regulations.

It allows low-income families who are unable to afford private insurance to receive coverage. Depending on where families fall on the Federal Poverty Level (FPL), they may receive low-cost or even free health care. 

Each state covers a set of mandatory services, while some opt to cover non-mandatory services, such as dental care or psychological care.

Note that Medicaid is different from the Children’s Health Insurance Program (CHIP), even though these programs are often coupled together.

There are two main ways to apply for Medicaid: through your state’s Medicaid agency or through the Health Insurance Marketplace.

Keep in mind that Medicaid may have a different name in your state.

For instance, the Arizona Medicaid program is called the Arizona Health Care Cost Containment System (AHCCCS), while the California program is called Medi-Cal.

Also, each state has its own set of regulations for the program.

Learn About Requirements for Medicaid

In general, your eligibility depends on where you and your family fall on the FPL.

It also depends on whether you live in a state that has chosen to expand Medicaid.

This expansion refers to the movement to extend the coverage of Medicaid programs so that individuals and families who fall below a certain income level can still receive affordable health care.

If you live in a state that offers expanded coverage, you may be able to qualify simply because your income is below a certain FPL percentage.

The state may then use other factors to determine your level of eligibility.

For some states, the qualifying FPL level is 133 percent, which becomes 138 percent when other calculations are taken into consideration. Other states have different percentage limits.

If you live in a state that does not offer expanded coverage, your state will determine your eligibility for Medicaid by assessing your income, household size, your disability or the disability of a family member and certain other factors.

Be sure to check the eligibility requirements in your state, because every state may have slightly different rules.

There are many misconceptions about who may qualify for Medicaid which are important to debunk.

For instance, some states allow you to apply for Medicaid if you are an immigrant or a member of your family is an immigrant.

You may also be able to apply if you are an American Indian or Alaskan Native, your status is recognized by the federal government and you receive assistance from the Indian Health Services, tribal health programs or urban Indian health programs.

In addition, you may still get coverage in some states even if you do not file taxes.

If you are not eligible for coverage and are an immigrant, you may still apply for your child without negatively impacting your chances of becoming a legal resident or citizen.

How to Apply Through your State Medicaid Agency

First, visit your state’s Medicaid site. Though your state’s program may go by a different name, it will still be relatively easy to find.

However, you may also visit the Medicaid government website and select the state overviews option.

You may then choose your state from a map to see the details of its low-income health program.

In general, you must create an online profile to begin the process. Then, the site will typically guide you through a series of questions to pre-determine your eligibility.

You may be prompted to submit the following information:

  • Your full name and date of birth
  • Mailing address or email address
  • Phone number
  • Social Security Number (SSN), or a document from the Social Security Administration (SSA) or another government entity which shows you are legally present
  • Income information for you and your family
  • And more

Some states, such as California, allow you to apply by mail or in person at a local health care office.

Research your state for details on what type of application methods are offered.

If you choose to apply by mail or in person, you may need to submit verification of your identity along with your application.

Make sure that all the information you provide is accurate. Inaccurate information may negatively impact your chances at qualifying for coverage.

Additionally, you may want to apply for benefits from another program for children’s healthcare, food stamps and temporary assistance.

If so, some states require you to complete separate applications for these programs.

How to Apply Through the Health Insurance Marketplace

To apply through the Health Insurance Marketplace, visit the federal HealthCare website.

It may say that open enrollment is over depending on the time of year. However, you may still use the site to determine whether you are eligible for Medicaid.

First, enter your zip code and select the Medicaid and CHIP option.

The site will redirect you to your state’s Marketplace website if your state has its own site.

If your state does not have its own Marketplace site, you may use the Marketplace quick screener to determine your eligibility in your state.

If you qualify for Medicaid, you also qualify for the special enrollment period.

This means you may enroll outside of the open enrollment period, which occurs every year.

Whether or not the quick screener pre-qualifies you, you may create an account with the HealthCare website and begin an application.

The quick screener will give you a good idea of your eligibility status, but the only way to know this for certain is to fill out and submit an application.

Learn About Different Enrollment Strategies Used for Medicaid Coverage

States have implemented different enrollment strategies into their programs designed by the Affordable Care Act.

You will encounter at least one of these strategies when applying for Medicaid.

They include presumptive eligibility, for instance, which helps hasten the application process if you and your family are likely to qualify.

Certain healthcare providers and community organizations will thus have the authorization to screen you for eligibility if you go to them for help.

Other states use express lane eligibility to simplify the enrollment and renewal process, which allows them to analyze your income tax data.

There is also continuous eligibility, which may apply to your children if they need more constant care throughout the year despite changes to your income.

Finally, states may choose to offer coverage to you if you are a legal resident in the U.S. and have children or are expecting.

This is called Medicaid for lawfully residing immigrant children and pregnant women. If you do not qualify for Medicaid, you may want to consider applying for WIC and other monetary assistance programs.