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How to Enroll in Medicaid: Who Qualifies and How to Apply

By KPCB StaffCombined Expertise In The Low Income Housing Space For 10 Years · How we write our guides

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To enroll in Medicaid, you apply through your state Medicaid agency or through HealthCare.gov, and you can do it any time of year. Applying is free. Only your state agency can decide whether you qualify, so apply even if you are not sure. You might qualify through a rule you don't know about, especially if you are pregnant, have children or have a disability.

How Medicaid works

Medicaid is free or low-cost health coverage run jointly by the federal government and each state. It covers low-income adults, children, pregnant women, older adults and people with disabilities.

Every state has to follow federal rules, but each one sets its own income limits, benefits and costs. Some states pay doctors directly. Others enroll you in a private health plan that manages your Medicaid care.

Who qualifies

Your state looks at your income, household size, age, disability, pregnancy, whether you care for children, and other factors. You also have to live in the state where you apply and meet citizenship or immigration rules.

Income and Medicaid expansion

Under the Affordable Care Act, states can expand Medicaid to cover adults based on income alone. In an expansion state, you can generally qualify if your household income is below 138% of the federal poverty level (FPL). HealthCare.gov notes that a few states use a different limit.

As of October 2026, KFF's tracker lists 41 states (counting DC) that have expanded Medicaid and 10 that have not: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.

If you live in one of those 10 states, you can still qualify through another group, such as pregnancy, disability, age or being the parent of a young child. HealthCare.gov says to fill out an application anyway.

Here is roughly what 138% of the 2026 poverty guideline works out to. These figures are for the 48 contiguous states and DC (Alaska and Hawaii are higher). Your state's exact limit and the way it counts income may differ, so treat this as a rough guide.

Household size138% FPL per year (2026)Per month
1about $22,025about $1,835
2about $29,863about $2,489
3about $37,702about $3,142
4about $45,540about $3,795

Source: HHS ASPE 2026 poverty guidelines chart. Children and pregnant women in families that earn too much for Medicaid may still qualify for CHIP.

Medicaid counts "modified adjusted gross income" (MAGI) for most adults, children and pregnant women. For most people, that is about the same as the adjusted gross income on a federal tax return. Supplemental Security Income (SSI) is not counted in MAGI. Older adults and people applying based on a disability may be judged under different rules, including asset limits in some states.

You can check whether you might qualify based on income on HealthCare.gov, or use our benefit finder to see which programs fit your situation.

Immigration status rules changed October 1, 2026

A 2025 federal law (Public Law 119-21) narrowed which immigrants can get full Medicaid or CHIP. Starting October 1, 2026, CMS says full coverage is limited to these groups:

  • U.S. citizens and nationals
  • Lawful permanent residents (green card holders)
  • Cuban and Haitian entrants
  • Compact of Free Association (COFA) migrants

Many lawful permanent residents still have a five-year waiting period. Some states also cover children and pregnant women who are "lawfully residing" in the U.S. Emergency Medicaid, which pays for treatment of an emergency medical condition, is not affected by this change. Ask your state agency how these rules apply to your family.

How to apply for Medicaid

Step 1: Choose how to apply

Federal rules require every state to accept Medicaid applications online, by phone, by mail and in person. You have two main routes.

  • Apply through your state Medicaid agency. Find your state's website and phone number on Medicaid.gov's state contact page.
  • Apply through the HealthCare.gov Marketplace. If it looks like someone in your household qualifies for Medicaid or CHIP, the Marketplace sends your information to your state, and the state contacts you. The same application also checks whether you qualify for savings on a Marketplace plan.

The Marketplace Call Center is 1-800-318-2596 (TTY 1-855-889-4325). HealthCare.gov also has a local help search for trained helpers who assist for free.

Step 2: Gather your information

Having these ready makes the application faster. HealthCare.gov's application checklist covers most of them.

  • Name, date of birth and home and mailing address for everyone applying
  • Social Security numbers for everyone in your household who has one
  • Immigration document information for any lawfully present immigrant applying
  • How you file taxes and who you claim as dependents
  • Income for everyone in the household: pay stubs, W-2s, self-employment income, unemployment and Social Security payments
  • Information about any health coverage you already have

Your state may ask for more, such as proof of pregnancy or records about a disability. It can only ask for information it needs to decide eligibility, and it cannot require an in-person interview for most income-based applications.

Step 3: Submit and watch your mail

Answer every question, list everyone in your household, and keep copies of what you send. If the agency asks for more information, send it by the deadline on the letter. A state can deny your application if required paperwork never arrives.

How long it takes and what happens next

Federal rules give states up to 90 days to decide if you apply based on a disability and up to 45 days for everyone else. Delays are allowed in unusual cases, such as when the agency is waiting on something from you.

If you are approved, you get a notice and usually a Medicaid card. If you are in a health plan, the member services number is on your letter or the back of your card.

You can use your coverage before the card arrives. HealthCare.gov says to show your provider a copy of your eligibility letter. At the pharmacy, bring the letter with your prescription. If the pharmacy cannot fill it, most can give you a 3-day supply while you call your agency or plan.

Medicaid can pay some older medical bills

Right now, Medicaid can help pay for medical care you got in the 3 months before you applied, if you would have qualified at the time. That changes for applications made on or after January 1, 2027. According to CMS, the look-back will be 1 month for adults in the expansion group and 2 months for everyone else. If you have recent medical bills, apply before the end of 2026 if you can.

If you are denied

Your denial notice has to give the specific reason and explain your right to a fair hearing. Federal rules let states set the deadline, but it can't be more than 90 days from the date the notice was mailed. Check your notice for your state's exact deadline.

If you already have Medicaid and the state plans to end or cut it, you should get a notice at least 10 days before the change. If you ask for a hearing before that date, the state generally has to keep your coverage until the hearing decision. If you lose the hearing, the state may try to recover what it paid for that care.

When Medicaid denies you or ends your coverage, the state usually sends your information to the Marketplace. You may be able to buy a Marketplace plan with savings, and you don't have to wait for the Marketplace to contact you. If your state hasn't expanded Medicaid and your income is below the poverty level, you may not qualify for Marketplace savings either. HealthCare.gov points people in that spot to community health centers, which charge based on income.

For help with an appeal, look for free legal aid in your state at LawHelp.org.

Keeping Medicaid: renewals and reporting changes

Medicaid has to be renewed. Your state checks at least once a year whether you still qualify. It must first try to renew you using information it already has. If it can't, it mails you a renewal form with some of your information already filled in, and you get at least 30 days to return it.

If you lose coverage because you missed the form, you can usually send it in within 90 days and have your state reconsider without a new application. Report changes in income, address or household size between renewals, and keep your mailing address up to date so you get your notices.

Watch for scam calls and texts about renewals. HealthCare.gov says your state will never ask for credit card information or payment to keep or qualify for coverage.

Changes for expansion adults starting in 2027

Public Law 119-21, which CMS calls the "Working Families Tax Cut" legislation, adds new rules for adults covered through Medicaid expansion. Here is how CMS describes them.

Work and community engagement requirement

Beginning January 1, 2027, states must require "applicable individuals" (mainly expansion adults ages 19 to 64) to show community engagement to get or keep Medicaid. States may start earlier. You can meet it with a combined 80 hours a month of work, community service or a work program, or by going to school at least half-time, among other ways.

Many people are excluded. The list includes pregnant and postpartum women, parents and caregivers of a child under 14 or a person with a disability, people who are medically frail (including people who are blind or disabled), former foster youth, certain American Indians and Alaska Natives, veterans with a total disability rating, people who already meet TANF work requirements, and members of SNAP households who are subject to SNAP work rules. People under 19 and people on Medicare don't have to meet it either.

If your state can't confirm that you meet the requirement, CMS says it must send you a notice and give you 30 calendar days to show you meet it or that you are exempt. States also have to send outreach about the requirement before it starts. Read every letter from your Medicaid agency and answer by the deadline.

Renewals every 6 months

For renewals scheduled on or after January 1, 2027, states must renew expansion adults every 6 months instead of every 12. People in other Medicaid groups keep yearly renewals.

Copays starting in 2028

Starting October 1, 2028, states must charge cost sharing to expansion adults with income above 100% FPL. CMS says it can't be more than $35 for any service. Primary care, behavioral health and community health center visits are exempt.

If Medicaid isn't the right fit

If your children don't qualify for Medicaid, they may qualify for CHIP, which covers kids in families that earn too much for Medicaid. See our guide to enrolling in CHIP.

If you are 65 or older or have a disability, you may also qualify for Medicare. Our guide to applying for Medicare online explains the steps. If you also need help with food, read how to apply for SNAP.

Frequently asked questions

Does it cost anything to apply for Medicaid?

No. Applying is free through your state agency or HealthCare.gov. Free help is available from Marketplace assisters, and HealthCare.gov says they will never ask for a credit card number or any form of payment.

Can I apply for Medicaid any time of year?

Yes. HealthCare.gov says you can apply for Medicaid and CHIP any time of year, so you don't have to wait for open enrollment.

My state hasn't expanded Medicaid. Should I still apply?

Yes. Every state covers some low-income groups, including families and children, pregnant women, older adults and people with disabilities. HealthCare.gov says to apply even if your state hasn't expanded.

What does Medicaid cover?

Every state must cover hospital care, doctor visits, lab work and X-rays, nursing facility care, home health, family planning, and rides to medical appointments. Children get regular checkups and needed treatment through a benefit called EPSDT. Dental, vision and some other services are optional under federal law, so coverage varies by state. Ask your state agency or health plan what is covered.

Can I have Medicaid and a Marketplace plan at the same time?

You can, but if you qualify for full Medicaid you can't get Marketplace savings, so you would pay full price for the plan. HealthCare.gov says to end your Marketplace plan when your Medicaid starts.

Who decides if I qualify?

Only your state Medicaid agency. Online screeners, including HealthCare.gov's income check and our benefit finder, can only tell you whether you might qualify.

Sources

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