How to Apply for Medicaid Health Coverage in Your State

Last updated 7 days ago. Our resources are updated regularly but please keep in mind that links, programs, policies, and contact information do change.

Medicaid provides free or low-cost health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. As a jointly funded federal-state program, each state administers Medicaid according to federal requirements while establishing their own specific rules.

This guide will help you understand Medicaid eligibility requirements and navigate the application process in your state.

Understanding the Basics of Medicaid

Medicaid is a means-tested entitlement program designed to finance essential health services for a diverse low-income population. It serves approximately 71.8 million people as of November 2024.

The program covers groups historically underserved by private insurance, offering benefits not typically found in private plans. These include:

• Long-term services and supports
• Non-emergency medical transportation
• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for children

While the federal government establishes broad guidelines and contributes significant funding, each state creates and administers its own Medicaid program. This leads to variations in eligibility rules, benefit packages, and application procedures across states.

Who Can Get Medicaid? Understanding Eligibility

Eligibility is determined based on a combination of federal requirements and state-specific criteria. Key factors that influence eligibility include:

• Income relative to the Federal Poverty Level (FPL)
• Household size
• Age (children, adults, seniors 65+)
• Disability status
• Pregnancy status
• U.S. citizenship or eligible immigration status
• State residency

Income Rules: MAGI and FPL

For most applicants—including children, pregnant women, parents, and adults under 65 without disabilities—financial eligibility uses Modified Adjusted Gross Income (MAGI) methodology. This standardized calculation is based on taxable income and tax filing relationships.

Your household’s MAGI is compared against the Federal Poverty Level (FPL), which varies based on household size. Here are the 2025 Federal Poverty Level guidelines for the 48 contiguous states and D.C.:

Non-MAGI Eligibility (Aged, Blind, Disabled)

MAGI rules don’t apply to individuals seeking Medicaid based on being 65 or older, blind, or having a disability. For these groups, eligibility typically includes both income and asset requirements.

Applicants often must have assets (savings accounts, stocks, bonds, and sometimes property other than their primary home) below certain thresholds—frequently $2,000 for an individual, though limits vary by state and program.

State Differences: Expansion and Other Variations

A major difference among states stems from the Affordable Care Act‘s Medicaid expansion provision:

• In Expansion States: Most adults under 65 can qualify based primarily on income, up to 138% FPL.
• In Non-Expansion States: Eligibility for adults under 65 who aren’t disabled is much more restricted, typically limited to specific categories like very low-income parents or pregnant women.

This creates a “coverage gap” in non-expansion states where some adults may earn too much for traditional Medicaid but too little (below 100% FPL) to qualify for Marketplace insurance subsidies.

Non-Financial Requirements

Besides financial criteria, applicants must meet non-financial requirements:

• State Residency: You must live in the state where you’re applying, with no minimum duration required.
• Citizenship/Immigration Status: You must be a U.S. citizen or fall within certain categories of qualified non-citizens. Some non-citizens who don’t meet these requirements may still get limited coverage for emergency conditions.

What Does Medicaid Cover?

Medicaid provides a broad range of health services, though specific benefits vary by state and eligibility category.

Mandatory Benefits

Federal law requires all state Medicaid programs to cover these essential services:

• Inpatient and outpatient hospital services
• Physician services
• Laboratory and X-ray services
• Nursing facility services (for ages 21+)
• Home health services
• Rural health clinic and Federally Qualified Health Center services
• Family planning services and supplies
• Nurse midwife services
• Certified pediatric and family nurse practitioner services
• Freestanding birth center services (if licensed by the state)
• Transportation to medical care
• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for individuals under 21

Optional Benefits

States may cover additional services beyond the mandatory set. Common optional benefits include:

• Prescription drugs
• Clinic services
• Physical, occupational, speech, hearing, and language therapy
• Dental services (adult coverage varies by state)
• Vision services/eyeglasses
• Mental health services
• Substance use disorder treatment
• Personal care services
• Case management
• Home and Community-Based Services (HCBS)
• Hospice care
• Prosthetic devices and dentures

Since coverage isn’t uniform across states or even all enrollees within a state, verify the specific benefits available through your state’s Medicaid program after approval.

How to Apply for Medicaid: Step-by-Step

Unlike Marketplace plans, you can apply for Medicaid or CHIP any time during the year.

Step 1: Gather Your Information and Documents

Prepare the following information and documents to speed up the application process:

• Identity: Valid driver’s license, state-issued ID, or U.S. Passport
• Social Security Numbers: For all individuals applying who have SSNs
• Citizenship/Immigration Status: U.S. birth certificate, U.S. Passport, Certificate of Naturalization, Permanent Resident Card, or other USCIS documents
• State Residency: Lease agreement, utility bill, driver’s license, etc.
• Income: Recent pay stubs, W-2 forms, tax returns, benefit award letters, self-employment records
• Household Information: Names, birth dates, and relationships for everyone in your household
• Health Insurance: Details about any current coverage
• Assets/Resources: For non-MAGI applicants (65+, blind, disabled), statements for bank accounts, investments, vehicles, property, etc.

Remember, not all documents are required for every applicant. Much verification often happens through electronic data sources initially. Don’t delay applying if you’re missing some documents—the state agency will follow up about any additional information needed.

Step 2: Choose How to Submit Your Application

States offer multiple application methods:

Applying online is typically fastest. Choose between the Health Insurance Marketplace or your state’s portal based on your situation:

• The Marketplace efficiently screens for multiple coverage types and works well for those likely eligible under MAGI rules
• Applying directly through your state agency may be more appropriate or required for those applying based on age, blindness, disability, or for specific programs like long-term care waivers

Step 3: What Happens After You Apply?

Once submitted, your state Medicaid agency begins reviewing your application:

1. Agency staff verify your information, often using electronic data sources first
2. If additional documentation is needed, they’ll contact you
3. Watch for communications and respond promptly to any requests
4. Processing time varies—generally up to 45 days for most applicants, up to 90 days if a disability determination is required
5. Many states offer online portals to check application status
6. You’ll receive an official written notice by mail about the eligibility decision

If approved, the notice will explain your coverage type, start date, and next steps. If denied, it will explain the reason and your right to appeal.

Finding Your State’s Medicaid Program

Since Medicaid is administered at the state level, locating the correct state agency is essential. Use these federal websites to find state-specific information:

• Medicaid.gov: Visit the Beneficiary Resources section for an interactive map and dropdown menu to find your state’s Medicaid agency
• HealthCare.gov: Check the Medicaid & CHIP section for state contact information
• USA.gov: Find links to state Medicaid agencies at USA.gov Medicaid and CHIP

These federal sites provide links to state resources but don’t administer individual state programs. For applying, checking status, reporting changes, or resolving issues, contact your specific state Medicaid agency directly.

State Examples: A Closer Look

Medicaid programs operate differently in each state. Here are examples from five diverse states:

California (CA)

• Program Name: Medi-Cal
• Application Portals: Covered California or BenefitsCal
• Key Features: Expansion state covering adults up to 138% FPL and children up to 266% FPL; offers the Medi-Cal Access Program for pregnant individuals in middle-income families

Texas (TX)

• Program Name: Texas Medicaid (services delivered through managed care plans like STAR, STAR Kids, STAR+PLUS)
• Application Portal: Your Texas Benefits
• Key Features: Non-expansion state with limited eligibility for non-disabled adults under 65; applications accepted online, by phone (2-1-1), by mail, or in person

New York (NY)

• Program Name: New York State Medicaid
• Application Portals: NY State of Health for MAGI groups; Local Department of Social Services for non-MAGI groups
• Key Features: Expansion state with distinct application pathways; offers the Essential Plan for those with incomes just above Medicaid levels

Florida (FL)

• Program Name: Florida Medicaid (most recipients enroll in Statewide Medicaid Managed Care)
• Application Portal: ACCESS Florida
• Key Features: Non-expansion state with limited eligibility for non-disabled adults; offers the Medically Needy program with “share of cost”

Vermont (VT)

• Program Name: Vermont Medicaid/Green Mountain Care (Dr. Dynasaur for children and pregnant individuals)
• Application Portal: Vermont Health Connect
• Key Features: Expansion state using state-based marketplace as single entry point; specific processes for Medicaid for the Aged, Blind, and Disabled

These examples highlight the differences in program names, application portals, and eligibility features across states, reinforcing the need to seek information specific to your state of residence.

Our articles make government information more accessible. Please consult a qualified professional for financial, legal, or health advice specific to your circumstances.