Medicaid: Who Qualifies and How to Apply

What Medicaid is

Medicaid is the largest source of health coverage in the United States, covering more than 80 million people. It's a joint federal-state program, which means eligibility and benefits vary by state.

Unlike Medicare (which is for people 65+ regardless of income), Medicaid is for low-income individuals and families of any age.

Need help applying? Call 211 to be connected with someone in your state who can walk you through the application.

Who qualifies

Medicaid eligibility is based on income relative to the Federal Poverty Level (FPL). Limits vary widely:

• In states that expanded Medicaid under the ACA (40 states + DC): adults under 65 qualify if income is at or below 138% of FPL (~$20,783 for a single person, ~$35,632 for a family of 3 in 2026).
• In states that didn't expand (10 states, mostly southern): adults often only qualify if they're a parent of a minor child AND have very low income, or are pregnant, disabled, or 65+.
• Children under 19: most states cover kids in families up to 200%–300% of FPL through Medicaid or CHIP.
• Pregnant women: covered up to at least 138% of FPL in all states.

How to apply

1. Apply year-round. Unlike Marketplace plans, Medicaid has no enrollment window — apply any time.
2. Three ways to apply:
   • Visit your state Medicaid agency website (search "[your state] Medicaid apply")
   • Apply through Healthcare.gov — they'll route you automatically
   • Apply in person at your county Department of Social Services / Human Services
3. Documents you'll need:
   • Photo ID
   • Proof of income (pay stubs, tax returns, benefit letters)
   • Social Security numbers for all household members
   • Proof of citizenship or immigration status
4. Approval typically takes 30–45 days. If approved, coverage is usually retroactive up to 3 months, meaning medical bills from before approval may be covered.

What it covers

Federal law requires Medicaid to cover:

• Inpatient and outpatient hospital care
• Doctor visits
• Lab work and X-rays
• Pediatric and prenatal care
• Long-term care
• Prescription drugs (in most states)

Many states cover additional benefits like dental, vision, mental health, and physical therapy.

CHIP for kids

If your kids don't qualify for Medicaid because your income is slightly too high, the Children's Health Insurance Program (CHIP) covers them up to higher limits. Same application — apply in one place.

Medicaid vs. ACA Marketplace

If your income is too high for Medicaid but you can't afford private insurance, the ACA Marketplace (Healthcare.gov) offers premium subsidies that can dramatically lower costs. Many people pay $0–$50/month with subsidies.

Marketplace help: 1-800-318-2596 (Healthcare.gov, 24/7)

A note from us

Medicaid eligibility varies significantly by state. A team members know your state's specific income thresholds, the asset rules, the application path, and the documentation you'll need. Call (844) 572-3682 and we'll tell you what to expect.