How to Apply for Medicaid and CHIP: Who Qualifies, Steps and What to Do If Denied

Medicaid and the Children’s Health Insurance Program (CHIP) are public health coverage programs paid for jointly by the federal government and the states. For people who qualify, they can mean doctor visits, hospital care, prescriptions and checkups with little or no out-of-pocket cost. Because each state runs its own program within federal rules, the details about who qualifies and what is covered depend on where you live. This guide walks through the process from first question to final decision, and explains a few changes that are on the way.

Who may qualify

Medicaid is not one single income cutoff. States look at several things together: your household size, your income, your age, whether you are pregnant or have a disability, whether you care for a child, and your immigration status. Some states have expanded Medicaid to cover adults whose income is under a set level. Others have not, and in those states adults without children or a disability often have fewer options.

CHIP covers children, and in some states pregnant people, in families that earn too much for Medicaid but not enough to easily afford private insurance. Some states run CHIP as part of Medicaid and others run a separate program, but for families the experience is similar: you submit one application, and the state decides which program fits.

On immigration status, full coverage is generally limited to people with certain lawful statuses, such as green card holders. Some states also cover lawfully residing children and pregnant people. Federal law also allows limited emergency coverage for people who would otherwise qualify but do not have an eligible status. Rules about who in a household must provide status information can differ when a parent is applying only for a child, so ask your state agency or a trusted local legal aid group how to complete the form if you are unsure.

The most useful advice from the government itself is simple: apply even if you think your income is too high. States use different rules for different groups, and you could qualify in a category you did not know existed. If you are found ineligible, you will usually be pointed toward Marketplace coverage, where income-based savings may be available.

Two ways to apply

1. Directly through your state. Medicaid.gov keeps a list of state Medicaid agencies with links to each program. Most states let you apply online, by phone, by mail or in person at a county office or community partner.
2. Through HealthCare.gov. Create an account and fill out the application. If anyone in your household appears eligible for Medicaid or CHIP, your information is sent securely to your state agency, which will contact you. The same application also shows whether you qualify for savings on a Marketplace plan. In states that run their own Marketplace, you apply on the state website instead.

What to prepare

Requirements differ by state, but most applications ask for:

• Names, birth dates and, where available, Social Security numbers for everyone applying.
• Proof of identity and that you live in the state, such as a driver’s license, utility bill or lease.
• Income information for the household, such as recent pay stubs, a benefits letter, or records if you are self-employed or paid in cash.
• Immigration documents for household members who are applying and are not citizens.
• Details about any other health coverage you have, including coverage through a job.

If you are missing something, submit the application anyway. The agency can often check some information electronically, and it will send you a notice listing anything else it needs and the deadline for sending it.

What happens after you apply

You may get a request for more information, a phone call, or a notice by mail or in your online account. Read every notice, because missed deadlines are one of the most common reasons for a denial that could have been avoided. Processing times vary from days to a couple of months depending on your state and whether the agency needs a disability review. If your application seems stuck, call the number on your notice, give your name and application number, and ask what is still pending.

When you are approved, the notice will tell you which program you are in, when coverage starts and how to choose a health plan if your state uses managed care. If you had medical care shortly before you applied, ask the agency whether coverage can start earlier than your application date, since the rules on this vary by state and have been changing.

What Medicaid and CHIP cover

Medicaid must cover core services such as hospital stays, doctor visits, lab tests and X-rays, and home health care. States choose whether to offer many other benefits, including adult dental care, which varies widely. For children, Medicaid includes a benefit called EPSDT (Early and Periodic Screening, Diagnostic and Treatment), which covers checkups and medically necessary treatment, including dental care. Children in separate CHIP programs also get dental coverage, though the exact package depends on the state.

To find a dentist who takes Medicaid or CHIP for a child, the federal InsureKidsNow site has a dentist locator and a phone line, 1-877-543-7669. For more on dental options, see our guide to free and low-cost dental care, and for medicine costs, our prescription savings guide.

Keeping your coverage: renewals

Medicaid and CHIP are not permanent once you are approved. Your state periodically checks whether you still qualify. Often this happens automatically using data the state already has, but you may be asked to confirm information and return a form by a deadline. Keep your mailing address, phone number and email current with the agency, and open anything that looks like it came from the Medicaid office. A missed renewal form can end coverage even when you still qualify, so respond by the date on the notice.

If you are denied

1. Read the denial notice. It must explain the reason. Common reasons include missing paperwork, income reported higher than it is, or an incomplete household list.
2. Fix what you can. If the problem was missing documents, call the agency and ask whether you can submit them and have the application reopened.
3. Ask for a fair hearing. You have a legal right to appeal. The notice explains how to request a hearing and the deadline, which can be short, so act quickly. You can ask for help from a legal aid office; see our guide to free legal aid.
4. Check Marketplace options. In most cases, a Medicaid denial means your information is sent to the Marketplace, but you do not have to wait for that letter to apply there. Marketplace enrollment normally happens during open enrollment each fall, though losing coverage can open a special window.
5. Reapply if your situation changes. A new baby, a lost job or a drop in hours can change the answer.

Where to get help

Community health centers and many hospitals have enrollment helpers who can sit with you through the application at no cost. You can also dial 211 to be pointed to one; learn how 211 works. For a broader view of low-cost care while you wait on a decision, see our guide to low-cost healthcare.

Official sources

• HealthCare.gov: Medicaid and CHIP
• Medicaid.gov: Beneficiary resources and state Medicaid links
• Medicaid.gov: Children’s Health Insurance Program
• Medicaid.gov: Dental care
• InsureKidsNow.gov

How this guide differs from other healthcare guides

This guide is about applying for Medicaid and CHIP themselves: who may qualify, the two ways to apply, what to prepare, what happens after you apply, renewals, and what to do if denied.

The low-cost healthcare and prescriptions guide is broader. It covers clinics and low-cost care while you wait, or if you are not covered, and medicine savings. The prescriptions guide focuses on medicine costs only, including generics, assistance programmes and Medicare Extra Help, and the dental guide focuses on dental options only.

Frequently asked questions

Can I apply at any time of year? Yes. You can apply any time of year. There is no enrollment window, unlike most Marketplace plans.

What if I think my income is too high? Apply anyway. Apply even if you think your income is too high, because states use different rules for different groups, and you could qualify in a category you did not know existed.

What if I am missing a document? Submit the application anyway. The agency can often check some information electronically, and will send a notice listing what else is needed and the deadline.

What if I am denied? Read the denial notice, fix what you can, and ask for a fair hearing by the deadline in the notice. Then check Marketplace options, and reapply if your situation changes.

Do I have to renew? Yes. Medicaid and CHIP are not permanent once you are approved. Your state periodically checks whether you still qualify, so keep your mailing address, phone and email current, and return any renewal form by its deadline.

How this guide was researched and reviewed

The Low-Cost Finder Editorial Team prepares content from official agency and established nonprofit sources, checks it against those sources, and explains it in plain language. It is reviewed before publication and revisited when programmes change.