A guide to applying for Medicaid coverage, including eligibility requirements, required documents, the application process, and what to do after approval.
In the 40 expansion states, adults under 65 qualify with income up to 138% of the federal poverty level (about $20,783 for an individual in 2026). Non-expansion states have stricter limits, often requiring income below $5,000-$10,000 per year for adults without children.
Determine which eligibility category applies to you
Categories include: low-income adults, pregnant women (covered up to 200% FPL in most states), children under 19 (often up to 300% FPL via CHIP), seniors 65+, and people with disabilities. Pregnant women often receive the most generous coverage with no premiums or copays.
Check if your household size and composition affect eligibility
Medicaid counts your tax household, which includes you, your spouse if filing jointly, and tax dependents. A family of 4 in an expansion state can earn up to about $41,400 and still qualify. Household size significantly impacts the income threshold.
Verify your citizenship or immigration status qualifies
US citizens and nationals are eligible. Lawful permanent residents must typically wait 5 years, though many states have waived this waiting period. Undocumented immigrants are generally not eligible except for emergency Medicaid. DACA recipients are eligible in some states.
Gather Required Documents
Collect proof of identity for all applicants
Accepted documents include a driver's license, state ID, passport, or birth certificate. For children, a birth certificate is preferred. Make copies of everything before submitting. Applications with complete documentation are processed 40-60% faster.
Gather proof of income for the past 30 days
Bring your 2 most recent pay stubs, self-employment income records, Social Security benefit letters, unemployment statements, or a letter from your employer. If your income varies, provide 3 months of documentation to show the average.
Prepare proof of residency in your state
Utility bills, lease agreements, mortgage statements, or bank statements showing your address work. You must be a resident of the state where you apply. There is no minimum time you must have lived in the state to qualify.
Collect Social Security numbers for all household members
SSNs are required for all applicants. If a household member does not have an SSN (such as a non-applying undocumented family member), they can still be listed on the application. Their information is used only for determining household size and income.
Gather information about any current health insurance
If you have other coverage such as employer insurance or marketplace plans, bring the policy details. In some cases, Medicaid can be secondary insurance alongside other coverage. Having other insurance does not automatically disqualify you.
Submit Your Application
Apply online through your state's Medicaid portal or HealthCare.gov
Online applications are the fastest, typically taking 20-30 minutes. In states using the federal marketplace, you can apply at healthcare.gov. In states with their own exchanges, use the state portal. Save your confirmation number after submission.
Apply by phone if you need assistance
Call 1-800-318-2596 for the federal marketplace or your state's Medicaid hotline. Phone applications take 30-45 minutes. Interpreters are available in over 200 languages at no cost. Call early in the morning on weekdays for shorter wait times.
Apply in person at your local Department of Social Services if preferred
Bring all documents listed above. In-person applications allow you to ask questions and get immediate feedback on missing information. Some offices accept walk-ins, but scheduling an appointment reduces wait times from 2-3 hours to 30-45 minutes.
Request a paper application by mail if other options are not accessible
Mail-in applications are the slowest option, taking 10-14 days for delivery each way. Make copies of everything before mailing and use certified mail with return receipt. Processing begins when the application arrives, not when it was mailed.
After Submission
Track your application status online or by phone
States must process applications within 45 days (90 days for disability-based applications). Check your status weekly. If you have not received a decision in 45 days, file a fair hearing request, which expedites processing.
Respond to any requests for additional information within 10 days
If the state needs more documents, they will send a written request. Responding late is the number one reason for denials. Set a phone reminder to submit requested documents within 5 business days to build in a buffer.
Understand your appeal rights if denied
You have 90 days from the denial date to request a fair hearing. About 50% of Medicaid denials are due to missing information rather than actual ineligibility. Request your case file to identify exactly why you were denied before your hearing.
After Approval: Using Your Benefits
Choose a primary care provider from the Medicaid network
Most states require selecting a PCP within 30 days or one is assigned to you. About 72% of office-based physicians accept new Medicaid patients. Use your state's provider directory or call your managed care plan's member services for help.
Schedule preventive care appointments right away
Medicaid covers preventive services with zero copay, including annual physicals, immunizations, cancer screenings, and mental health screenings. Schedule these within your first 60 days of coverage to establish a health baseline.
Understand your renewal timeline and reporting obligations
Medicaid eligibility is redetermined every 12 months. Your state will send a renewal form 60-90 days before your coverage year ends. Report income changes within 10 days. About 18% of Medicaid enrollees lose coverage at renewal due to not completing paperwork.
Learn what services are covered by your state's plan
All states cover hospital stays, doctor visits, lab work, pregnancy care, and pediatric services. Many also cover dental, vision, prescriptions, and mental health. Coverage for adult dental and vision varies widely by state from none to full coverage.
Frequently Asked Questions
What is the income limit to qualify for Medicaid?
In the 40 states that expanded Medicaid under the ACA, adults under 65 qualify with household income up to 138% of the federal poverty level (about $20,783 for an individual or $43,056 for a family of 4 in 2025). In the 10 non-expansion states, eligibility is stricter and typically limited to parents, pregnant women, and people with disabilities. Income limits vary by state, so check your states Medicaid website for exact thresholds.
How long does the Medicaid application process take?
States must process applications within 45 days for most applicants and 90 days for disability-based applications. In practice, straightforward applications are often approved in 10-14 days. If additional documentation is requested, the clock resets. Apply online at your states Medicaid portal for the fastest processing. You can also apply by phone, mail, or in person at your local Department of Social Services.
What documents do I need to apply for Medicaid?
Gather proof of identity (drivers license or state ID), Social Security numbers for all household members, proof of income (pay stubs from the last 30 days, tax return, or employer letter), proof of residency (utility bill or lease), immigration status documents if applicable, and proof of any current health insurance. Having all documents ready before you start reduces processing delays by an average of 2 weeks.
Can I apply for Medicaid at any time or only during open enrollment?
Unlike marketplace insurance, Medicaid has no open enrollment period. You can apply any time of year, 365 days a year. If approved, coverage starts retroactively to the first day of the month you applied, and in many states, it covers medical bills from up to 3 months before your application date. Apply as soon as you think you may qualify since retroactive coverage can save you thousands.
What does Medicaid cover?
All state Medicaid programs must cover hospital stays, doctor visits, lab tests, X-rays, prenatal care, pediatric care, nursing facility services, and home health services. Most states also cover prescription drugs, dental (limited), vision, mental health services, and substance abuse treatment. Copays are minimal ($1-$4 per service) and many services have no copay at all. There are no deductibles or annual limits.