How to Apply for Medicaid: Step-by-Step Eligibility Guide

Healthcare is one of the most significant expenses American families face, and for millions of low-income individuals, Medicaid is the safety net that makes medical care possible. This guide covers who qualifies, how to apply, and what to do if you're denied.

What Is Medicaid?

Medicaid is the largest source of health coverage in the United States, covering over 90 million Americans. Unlike Medicare, which is primarily age-based, Medicaid eligibility is primarily income-based. Since the Affordable Care Act, many states have expanded Medicaid to cover adults with incomes up to 138% of the federal poverty level.

Who Qualifies for Medicaid?

Medicaid eligibility varies by state, but generally covers:

• Low-income adults and families with children

• Pregnant women (income limits are typically higher)

• Children through CHIP

• Adults aged 65 and older who meet income requirements

• People with qualifying disabilities receiving SSI

• Adults in expansion states earning up to 138% of the federal poverty level

Medicaid Income Limits

In expansion states, a single adult qualifies with approximately $1,732 or less monthly. A family of four qualifies with approximately $3,563 or less monthly. In non-expansion states, eligibility may be more restricted.

Step-by-Step: How to Apply

1. Visit HealthCare.gov or your state’s Medicaid website

2. Gather documents: proof of identity, income, residency, citizenship

3. Complete the application online, by phone, by mail, or in person

4. Submit supporting documents as requested

5. Receive a decision within 45 days (or 90 days for disability)

6. If approved, receive your Medicaid card and enroll in a managed care plan

What Does Medicaid Cover?

Medicaid provides comprehensive coverage including doctor visits, hospital stays, emergency care, mental health services, prescription drugs, lab tests, and preventive care. Many states also cover dental, vision, and hearing services.

What to Do If Denied

If denied, you have the right to appeal. Request a fair hearing within 90 days. Contact a legal aid organization for free help. If you don’t qualify for Medicaid, you may qualify for subsidized ACA Marketplace coverage.

Apply Today — Coverage May Be Retroactive

Medicaid coverage can be retroactive for up to three months before your application date. Don’t wait — apply as soon as possible through your state’s Medicaid portal or at HealthCare.gov.