Medicaid is one of the largest health coverage programs in the United States, covering low-income adults, children, pregnant women, elderly people, and people with disabilities. One of the persistent challenges with the program is that a significant number of people who qualify for it are not enrolled, often because they do not know they are eligible or are not sure how to apply. Eligibility varies considerably by state, so the starting point is always your specific state rules.
Eligibility is determined by state
The federal government sets minimum standards for Medicaid but states can expand coverage beyond those minimums. As a result, whether you qualify depends heavily on where you live. Some states have expanded Medicaid under the Affordable Care Act to cover adults with incomes up to 138 percent of the federal poverty level, regardless of whether they have children. Other states have not expanded and have narrower eligibility criteria. Your first step is to find out which category your state falls into.
Categories that may be covered
Medicaid covers several broad groups. Low-income children and their parents or caretakers. Pregnant women with incomes below state thresholds. People with disabilities who receive Supplemental Security Income. Elderly people with limited income and assets. In expansion states, low-income adults who do not fall into any of the above categories. Each group has its own income and eligibility rules, and there are also asset tests in some categories, particularly for long-term care Medicaid.
How to check your eligibility
The fastest route is healthcare.gov, where you can enter basic information about your household size and income and the site will tell you whether Medicaid might be an option and direct you to your state program. You can also go directly to your state Medicaid agency website. Benefits.gov has a benefits finder tool that asks about your situation and lists programs you may qualify for. Calling 211 connects you with local assistance navigators who can help you work out what you are eligible for and how to apply.
What you will typically need to apply
Applications generally require proof of identity, proof of residency in the state, proof of income for all household members, and information about other health insurance you may have. Some states have simplified applications and many allow online submission. Processing times vary. If you have an urgent medical situation, let the agency know, as some states have expedited processes for urgent cases.
CHIP for children who do not qualify for Medicaid
If your children do not qualify for Medicaid because your household income is above the threshold, they may still qualify for CHIP, the Children's Health Insurance Program, which covers children in families with incomes too high for Medicaid but who cannot afford private coverage. CHIP is also administered at the state level. InsureKidsNow.gov has information on both Medicaid and CHIP for children in each state.
This article is general educational information only. Medicaid rules vary significantly by state and change regularly. Check healthcare.gov or your state Medicaid agency for current eligibility information.
This is general educational information only, not legal, financial, or benefits advice. Medicaid eligibility rules vary by state and can change. Verify current information at healthcare.gov or with your state Medicaid agency.