Medicaid Navigator

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Application Guide

How to Apply for Medicaid

The application process varies by state, but here are the main paths:

1

Online: Apply through your state's Medicaid website or healthcare.gov (in states that use the federal marketplace). This is usually the fastest method.

2

In person: Visit your local Department of Social Services, county welfare office, or community health center. Bring your documents.

3

By phone: Call your state Medicaid office. Many states accept applications over the phone.

4

At the hospital: If you need immediate care, hospitals can help you apply for Medicaid on the spot. Many have enrollment specialists.

Documents you'll need: Proof of identity (ID, birth certificate), proof of income (pay stubs, tax return, SSA award letter), proof of residency (utility bill, lease), Social Security numbers for household members, and immigration status documents if applicable.

Processing time: States must process applications within 45 days (or 90 days for disability-based applications). Many states offer presumptive eligibility — temporary coverage while your full application is processed.

Dr. Ed's Insider Tip

Medicaid can be retroactive up to 3 months. If you had medical bills in the 3 months before you applied and would have been eligible, Medicaid may cover those bills retroactively. Always mention any recent unpaid medical expenses when you apply. This is one of the most overlooked Medicaid benefits.

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Already Enrolled

You're on Medicaid — Here's What to Know

Key things to stay on top of:

1

Renewals are critical. You must renew your Medicaid coverage — currently annually, but starting January 2027, expansion adults may need to renew every 6 months (pending final implementation by states). Watch your mail carefully and respond promptly.

2

Report changes. If your income, address, household size, or employment changes, report it to your state Medicaid office. Failure to report can cause problems at renewal.

3

Know your benefits. Medicaid covers doctor visits, hospital stays, prescriptions, lab work, and more. Many states also cover dental, vision, and mental health. Check your state's covered services.

4

Transportation benefit. Most state Medicaid programs provide free transportation to medical appointments. Call your Medicaid plan or state office to arrange rides.

Dr. Ed's Insider Tip

Keep your address updated! The #1 reason people lose Medicaid is because they didn't respond to a renewal notice — and the #1 reason they didn't respond is because the notice went to an old address. Update your address with your state Medicaid office every time you move. This one step can save your coverage.

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Urgent: Respond Quickly

Got a Medicaid Letter or Problem?

⏰ Critical deadline: If you received a notice of termination or reduction, you typically have 10 days from the date of the notice to request a fair hearing AND continue receiving benefits during the appeal. After 10 days, you can still appeal, but your benefits may stop while the appeal is pending.

⏱️ Check your deadline:

What date is on your Medicaid notice?

Common Medicaid letters:

This is routine. Complete and return the renewal form by the deadline. If you can do it online, that's fastest. Include any updated income information. If you don't respond, your coverage will end.

Don't panic — you have rights. Request a fair hearing within 10 days to keep your benefits active during the appeal. Common reasons for termination: income over the limit, missed renewal, moved out of state. If the reason is wrong, appeal immediately.

This could mean a change in your covered services, copay amounts, or managed care plan. Review the notice carefully. If you disagree with the change, you can request a fair hearing.

Dr. Ed's Insider Tip

The magic words: "I request a fair hearing and I want my benefits to continue." Say this within 10 days of the notice date. Put it in writing. Send it certified mail. This is your constitutional right under Goldberg v. Kelly — the state cannot cut your benefits without giving you a chance to be heard first, as long as you request the hearing in time.

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Dual Eligible

Medicare + Medicaid Together

If you qualify for both Medicare and Medicaid, you're "dual eligible" — and you may get significant help with your healthcare costs.

Medicare Savings Programs (2026):

QMB (Qualified Medicare Beneficiary): Income ≤ 100% FPL ($1,330/month individual). Medicaid pays your Part A premium, Part B premium ($202.90/mo), deductibles, and copays. Providers cannot bill you for Medicare cost-sharing.

SLMB (Specified Low-Income Medicare Beneficiary): Income ≤ 120% FPL ($1,596/month). Medicaid pays your Part B premium ($202.90/mo).

QI (Qualifying Individual): Income ≤ 135% FPL ($1,796/month). Medicaid pays your Part B premium. Must reapply each year; first-come, first-served funding.

Extra Help with Part D (LIS):

If you're dual eligible, you automatically qualify for Extra Help (Low Income Subsidy) which pays most of your Part D prescription drug costs — premiums, deductibles, and copays.

D-SNP Plans:

Dual Special Needs Plans (D-SNPs) are Medicare Advantage plans designed specifically for dual eligibles. They coordinate your Medicare and Medicaid benefits in one plan, often with extra benefits like dental, vision, hearing, transportation, and over-the-counter allowances.

Dr. Ed's Insider Tip

If you have QMB, doctors CANNOT bill you for copays or deductibles. This is federal law. If a provider tries to bill you for Medicare cost-sharing and you have QMB, show them your Medicaid card and tell them: "I have QMB — federal law prohibits balance billing." If they persist, report them to your state Medicaid office and 1-800-MEDICARE.

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Common Questions

Medicaid FAQ

It varies by state and category. In ACA expansion states, adults can qualify with income up to 138% of the Federal Poverty Level — about $22,083/year for an individual. For elderly/disabled individuals, limits are often tied to SSI levels. The 2026 FPL for an individual is $15,960/year ($1,330/month).

In most cases, yes. Your primary home is generally exempt from Medicaid's asset test (though there may be equity limits for long-term care). Vehicles, household goods, and personal belongings are also typically exempt. Asset limits vary by state — many states have eliminated asset tests for expansion adults.

Medicare is federal health insurance primarily for people 65+ (or with disabilities). Medicaid is a joint federal-state program for people with limited income. You can have both — that's called being 'dual eligible.' Medicare covers hospital and doctor visits; Medicaid may cover additional services like long-term care, dental, and transportation.

Yes! Many working people qualify for Medicaid, especially in expansion states. Your eligibility is based on your Modified Adjusted Gross Income (MAGI). If your income is below the limit, you qualify regardless of employment status.

Your coverage will likely be terminated. But don't give up — you can reapply immediately. In many states, if you reapply within a certain window, your coverage may be reinstated without a gap. Contact your state Medicaid office right away.

Yes — Medicaid is the primary payer for long-term care in the U.S. However, there are strict income and asset limits, and a 60-month (5-year) look-back period for asset transfers. Planning ahead is critical. Consult with an elder law attorney if you anticipate needing long-term care.

Starting January 1, 2027, adults enrolled through ACA Medicaid expansion will need to renew their eligibility every 6 months instead of annually. This change was enacted through federal legislation. States are developing implementation plans now. Stay informed and keep your contact information current.

It depends on immigration status. Lawful permanent residents (green card holders) may qualify after a 5-year waiting period in most states. Some states cover lawfully present immigrants without the waiting period. Undocumented immigrants generally cannot get full Medicaid, but may qualify for emergency Medicaid. Children and pregnant women often have broader eligibility.

Need to start over?

Go back to the beginning and choose a different path.

Quick Action Steps:

Get State-Specific Medicaid Help

How to Apply for Medicaid

You're on Medicaid — Here's What to Know

Key things to stay on top of:

Got a Medicaid Letter or Problem?

⏱️ Check your deadline:

Common Medicaid letters:

Medicare + Medicaid Together

Medicare Savings Programs (2026):

Extra Help with Part D (LIS):

D-SNP Plans:

Save your spot.

Medicaid FAQ

Need to start over?