How to Apply for Medicaid: Eligibility, Process, and What to Do If You Are Denied

Medicaid covers over 90 million Americans. It is free or very low cost. It covers a broad range of care. And in many states, it can be retroactive — meaning it can cover medical bills you already have.

Millions of people who qualify are not enrolled.

Some do not know they qualify. Some applied once, got confused, and gave up. Some were dropped during the post-pandemic unwinding — sometimes incorrectly. If any of that sounds like you, start here.

“A 2023 analysis found approximately 5 million Americans lost Medicaid coverage during the post-pandemic unwinding — many were terminated due to administrative errors, not because they became ineligible.”

Federal Medicaid Eligibility Basics

Medicaid eligibility is based primarily on your income and household size. Under the ACA's Medicaid expansion, adults earning up to 138% of the Federal Poverty Level generally qualify.

For 2025, 138% FPL for a single adult is approximately $20,120 per year. For a family of four, it is around $41,400.

Regulation Citation

Medicaid Eligibility Requirements

42 U.S.C. § 1396a; 42 CFR Part 435; ACA § 2001

In states that adopted Medicaid expansion, most adults earning up to 138% FPL qualify. In non-expansion states, eligibility is more restricted — typically requiring a specific category like pregnancy, disability, or being a parent of a minor child. The income measure used is MAGI — Modified Adjusted Gross Income.

Has Your State Expanded Medicaid?

As of 2025, 40 states plus DC have adopted Medicaid expansion. States that have not include: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.

If you live in a non-expansion state and do not qualify under traditional Medicaid categories, check whether you qualify for subsidized coverage through the ACA marketplace instead.

How to Apply

1
Check your eligibility first
Use Healthcare.gov's eligibility screener or your state Medicaid agency's website. Most have online tools that give you a preliminary answer in minutes. The income used is MAGI — not just your gross wages.
2
Apply online, by phone, or in person
Apply at Healthcare.gov (which routes to your state agency), directly through your state Medicaid website, by calling your state Medicaid hotline, or in person at your local Department of Social Services. Applications are free.
3
Gather your documents
You typically need: proof of identity, proof of residency, proof of income (pay stubs or tax return), Social Security numbers for everyone applying, and immigration documentation if applicable.
4
Submit and track your application
Most states must decide within 45 days — 90 days for disability-based applications. If your state takes longer without explanation, file a complaint with your state Medicaid agency and with CMS.

Retroactive Coverage — Apply Now Even If You Already Got Care

Here is something most people do not know: if approved, Medicaid in most states covers care from up to three months before the month you applied.

If you had a hospital visit, an ER trip, or other medical care in the past three months, apply for Medicaid now. If you qualify, Medicaid may cover those bills retroactively.

Your Fair Hearing Rights If You Are Denied

If your Medicaid application is denied, you have the right to a fair hearing. Request it within 90 days of the denial notice. Send your request in writing, certified mail.

At the hearing, you can present evidence, bring a representative, and challenge the state's determination. Many states allow legal aid attorneys to represent you at no cost.

Frequently Asked Questions

Can I have Medicaid and private insurance at the same time?

Yes — this is called dual coverage. Medicaid pays last, after your private insurance. This is common for people who have employer insurance but also qualify for Medicaid based on income. Having both can dramatically reduce your out-of-pocket costs. Tell your providers you have dual coverage so they bill both correctly.

What is the difference between Medicaid and Medicare?

Medicare is federal health insurance primarily for people 65 and older, or with certain disabilities. Medicaid is a joint federal-state program for low-income individuals of all ages. If you qualify for both — called dual eligibility — Medicare pays first and Medicaid covers many costs Medicare does not, including premiums, deductibles, and copays.

Does Medicaid cover dental and vision?

For children, yes — federal Medicaid law requires it. For adults, dental and vision are optional Medicaid benefits that vary by state. Some states cover adult dental. Some cover emergency extractions only. Some cover nothing. Check your state Medicaid website for the specific benefits your plan includes.

Can undocumented immigrants receive Medicaid?

Most undocumented immigrants are not eligible for federal Medicaid. However, federal law requires states to cover emergency Medicaid for anyone who meets income requirements, regardless of immigration status. Some states use their own funds to extend broader Medicaid coverage to undocumented residents. Children may also qualify for CHIP regardless of status in some states.

What happens to my Medicaid if my income increases?

You are required to report income changes to your state Medicaid agency. If your income rises above the threshold, you may lose coverage. But you typically get a transition period — and at that income level, you may now qualify for subsidized marketplace coverage with premium tax credits. Report changes promptly. Failure to report can lead to overpayments the state will try to recover.

What is Medicaid estate recovery?

Federal law requires states to seek reimbursement from the estates of deceased Medicaid recipients aged 55 or older who received certain services. The state can make a claim against your estate after you die. This does not affect your coverage while you are alive. Some states have broader estate recovery programs than others. Consult an elder law attorney if this is a concern.