Although Medicaid is a joint federal and state program the states operate the program on a day-to-day basis, including taking applications and making determinations of eligibility. That means you must contact a local office in your state to apply for Medicaid.
To apply for Medicaid you will have to:
- Fill out an application form
- Provide documentation to verify general and financial requirements
Once the state finds you eligible for Medicaid, you will have to go through a functional eligibility assessment if you want to receive long-term care services.
You may apply for Medicaid coverage yourself, or you may designate another person, such as a family member, your attorney, or a friend, to apply for you. If someone else apples for you, that person should be familiar with your situation, be able to answer all eligibility questions, and have access to your financial records. The state may also require a face-to-face interview.
If you own a home, the state may ask you to document the current fair market value of the home and any loans for the home, such as mortgages or equity loans. The state may ask for these documents:
- A current tax bill
- A real estate appraisal
- Copies of your mortgage
The state may ask for this documentation because, while your home is not counted as an asset when determining your eligibility for Medicaid, how much equity you have in your home can affect whether Medicaid will pay for your long-term care services. See the section on "Limits on Home Equity" for more information about this.
If the value of your assets went down a lot within the past five years, the state may ask you to explain what happened to the assets. In particular, the state will want to know whether you gave away any of your assets in the past five years.
If you are married and in a nursing home, you will also be asked to document your assets when you first entered the nursing home—this can help establish how much of your assets your spouse is able to keep. See the section on "Considerations for Married People" for more information about this.
Where to Apply for Medicaid:
All states have local Medicaid eligibility offices where you can file applications. Many states also provide applications at different locations in your community, including Aging and Disability Resource Centers (ADRCs). Your can also apply by phone by calling your local Medicaid office. In most states, you can also apply online, or find an application online that you can complete and mail to the local office.
Contact your State Medical Assistance Office to find out where and how you can apply for Medicaid benefits.
When to apply for Medicaid:
The best time to apply depends on your medical situation, your marital status, and the complexity of your finances. If your finances are straightforward, the state may be able to process your application faster. If you find that you need long-term care, you should apply as soon as possible because it may take some time for the state to process your application and make an eligibility determination. For the most part, the date you become eligible is based on the date you apply for Medicaid, assuming you meet all of the eligibility requirements when you apply. The longer you wait to apply, then, the later your date of eligibility will be.
The Medicaid agency usually has 45 days to process your application. If the application requires a disability determination, the agency can take 90 days. But, it may take longer for the state to determine your eligibility if you do not provide the required documents on time. If Medicaid thinks that you are not cooperating, it can deny your application for failing to cooperate. If this happens, you may have to start your application over again once you have your documents in hand. This will delay the date you become eligible for Medicaid even longer.
If the Medicaid agency determines that you are not eligible, you will receive a letter that explains the reason for denial. The notice will also explain how you can appeal the decision.
The Children’s Health Insurance Program (CHIP) offers health coverage to children. To be eligible, the child's family must have an income that is:
- Too high to qualify for Medicaid
- Too low to afford private coverage
Medicaid and CHIP program names are different in each state.
Learn About Medicaid
What help is available through Medicaid?
Medicaid provides free or low-cost medical benefits to eligible:
- Adults with a low income
- Children
- People who are pregnant
- People who are age 65 or over
- People with disabilities
Am I eligible for Medicaid?
Check with your state’s Medicaid office to see if you or your family members are eligible for benefits. In general, it depends on at least one or a combination of:
- Age
- Income level
- Number of people in your family
- If you are pregnant or have a disability
How do I apply for Medicaid?
There are two ways to apply for Medicaid:
- Contact your state Medicaid agency. You must be a resident of the state where you are applying for benefits.
- Fill out an application through the Health Insurance Marketplace.
Learn About the Children’s Health Insurance Program (CHIP)
If your income is too high for Medicaid, your child may still qualify for the Children’s Health Insurance Program (CHIP). It covers medical and dental care for uninsured children and teens up to age 19.
Is my child eligible for CHIP?
CHIP qualifications are different in every state. In most cases, they depend on income.
How do I apply for CHIP benefits?
You have two ways to apply for CHIP:
- Find a program by state, or call the Health Insurance Marketplace at 1-800-318-2596 (TTY: 1-855-889-4325).
- Fill out an application through the Health Insurance Marketplace.
What else do I need to know about CHIP?
- You can apply for and enroll in Medicaid or CHIP anytime during the year.
- Learn how to use your Medicaid or CHIP coverage.
- Like Medicaid and CHIP, the Basic Health Program (BHP) offers affordable, continuous coverage. It’s an optional program that your state may offer. It’s available to people with incomes that shift above and below Medicaid or CHIP levels.
- Get information on other common types of health insurance, such as Medicare, and find help paying for medical bills.
File a Complaint About Medicaid or CHIP
If you have a problem with Medicaid or CHIP services, you can file a complaint. These programs are managed by each state rather than the federal government. Contact your state's Medicaid program to report your issue.