Health Care & Medicare Help › Guide
Medicaid Eligibility, Coverage, and How to Apply
Medicaid gives free or low-cost health coverage to people who meet state rules. Children, pregnant people, adults, older adults, and people with a disability may qualify. You can apply at any time, and applying is free.
Income is important, but it is not the only rule. Your state makes the final choice.
Who may qualify for Medicaid?
Every state covers some people in these groups:
- Children and teens
- Pregnant people
- Parents and other adults who care for a child
- People age 65 or older
- People who are blind or have a disability
Some states cover more groups. A child may get Medicaid or CHIP even when a parent does not.
What is Medicaid expansion?
Many states expanded Medicaid for adults under age 65. In those states, an adult may qualify based on income alone when household income is below about 138% of the federal poverty level.
Some states did not expand the same way. Their adult rules may be tighter, but rules for a child, pregnancy, age, or disability can still help. Apply even if a quick chart says no.
Use our Medicaid calculator for a first check. It is not a state decision.
What does Medicaid cover?
Each state plan is different. Medicaid often covers:
- Doctor and clinic visits
- Hospital and emergency care
- Lab tests and X-rays
- Medicine
- Mental health and substance use care
- Pregnancy and birth care
- Home or nursing care for some people
Child coverage has broad federal rules. Adult dental, eye, ride, and home-care benefits differ by state. Ask which doctors, drugs, and services are in your plan.
What papers should you gather?
- Names and birth dates for people in the home
- Pay stubs and other income facts
- Social Security numbers when asked
- Citizenship or immigration proof for each person who applies
- Facts about job health coverage
- A safe mailing and email address
A parent can apply for a child without seeking coverage for the parent. The state should only ask for the facts it needs for the person who applies.
How do you apply?
- Use HealthCare.gov's state finder.
- Apply on your state Medicaid site or through the Marketplace.
- Send missing proof by the due date.
- Save the form, case number, and decision letter.
You can apply all year. You do not need to wait for the Marketplace open sign-up period.
What if the state says no?
Read the reason. Check the income, family size, age, pregnancy, and disability facts. The letter will say how to ask for a fair hearing if a fact is wrong.
If income is too high, check CHIP for a child and a Marketplace plan for an adult. Our Marketplace savings guide explains the two types of help.
How do you keep coverage?
Open all mail from the state. Report a new address. Send renewal facts on time, even if your income did not change.
If coverage ends, ask why and when it stops. You may have a short time to appeal or choose other coverage. Keep your plan card until you know the end date.
Run your numbers. The free Medicaid calculator shows your state's Medicaid income test — with a straight answer if your state did not expand. Nothing you type is saved. All calculators →
Application toolkit · verified 2026-07-28
Get ready to apply for Medicaid
Medicaid rules and verification are state-specific. Gather the information below, but use your state's request as the final checklist.
Common documents and information
Check off items as you gather them. Do not send original records unless the agency specifically tells you to.
What happens after you apply
- Save the application ID, submission date, and a copy of everything you submitted.
- If you applied through HealthCare.gov and someone appears eligible, the Marketplace securely sends the information to the state Medicaid agency. The state then contacts you.
- Respond promptly if the state requests documents or clarification, and keep your address, phone, and email current.
- Read the state's eligibility notice. If approved, follow its instructions about a health plan or enrollment card. If denied, the notice must explain appeal rights; you may also qualify for Marketplace coverage.
Applying is free. CalculateBenefits does not receive or submit your application.
Local rules: Income rules, application questions, documents, health-plan enrollment, and appeal procedures differ by state and eligibility group.
Sources
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