Medicaid Enrollment: A Step-by-Step Guide to Getting Covered
Medicaid provides health coverage to millions of low-income Americans, covering everything from doctor visits to hospital stays to prescription medications. If you think you might qualify, this guide walks you through the enrollment process step by step so you can get the healthcare coverage you need.
Who Qualifies for Medicaid?
Medicaid eligibility varies by state, but generally covers low-income individuals in these categories:
- Adults with income below 138% of the federal poverty level (in expansion states)
- Children in families with low to moderate income
- Pregnant women
- Seniors age 65 and older
- People with disabilities
- Parents and caretakers of dependent children
Understanding Medicaid Expansion
Under the Affordable Care Act, states can expand Medicaid to cover more adults. As of 2024, 40 states plus Washington D.C. have expanded Medicaid. In expansion states, most adults earning up to about $20,000 per year (for an individual) qualify. In non-expansion states, eligibility is more limited.
How to Apply for Medicaid
There are several ways to apply for Medicaid coverage:
- Online through Healthcare.gov (which will direct you to your state agency)
- Through your state Medicaid agency website
- By phone—call your state Medicaid office
- In person at your local Department of Social Services
- By mail using a paper application
- Through a community organization or navigator
Documents You Will Need
Gather these documents before starting your application:
- Social Security numbers for everyone applying
- Proof of citizenship or immigration status
- Proof of income (pay stubs, tax returns, benefit letters)
- Proof of residence in your state
- Date of birth documentation
- Information about current health insurance if any
The Application Timeline
Understanding the timeline helps you plan accordingly:
- You can apply any time—there is no enrollment period for Medicaid
- States must process applications within 45 days (90 days for disability-based applications)
- Many applications are approved much faster, sometimes within days
- Coverage can be retroactive up to 3 months before your application date
- You will receive a notice about your eligibility determination
What Medicaid Covers
Medicaid provides comprehensive coverage including:
- Doctor visits and preventive care
- Hospital stays and emergency services
- Prescription medications
- Lab tests and X-rays
- Mental health and substance abuse treatment
- Maternity and newborn care
- Pediatric services including dental and vision for children
If You Are Denied
If your application is denied, you have the right to appeal. Your denial notice will explain the reason and how to request a hearing. Common reasons for denial include income being too high or missing documentation. Often, providing additional information can resolve the issue.
Getting Help with Your Application
Free help is available if you need assistance:
- Certified application counselors at community health centers
- Navigators funded to help with healthcare enrollment
- Social workers at hospitals and clinics
- Your state Medicaid helpline
- Legal aid organizations for complex cases
Having health insurance means you can get the care you need without worrying about crushing medical bills. If you think you might qualify for Medicaid, apply today. The process is free, and you have nothing to lose by checking your eligibility.
