How Medicaid enrollment works

Medicaid is run by your state, not by the federal government, so the steps to enroll depend on where you live. Most states use an online portal where you create an account, enter your household income and size, and upload documents like pay stubs or a lease. Some states still accept paper applications by mail. A few states use a phone line. Your state's Medicaid office will tell you which method they use and whether you can enroll year-round or only during open enrollment periods.

The process usually takes two to four weeks from the time you submit a complete application. Some states are faster; some take longer. If your state uses continuous enrollment (which most do for Medicaid, unlike marketplace insurance), you can start the process any month. You will need to provide proof of income, citizenship or immigration status, and residency — typically a recent pay stub, a utility bill, and a Social Security number or ITIN.

Key Takeaways

  • Each state runs its own Medicaid program, so you enroll through your state's Medicaid office or health department website, not a federal portal.
  • You will need to prove your household income, citizenship or immigration status, and state residency with documents like pay stubs, utility bills, and a lease.
  • Most states accept applications year-round and process them within two to four weeks if your paperwork is complete.
  • If you are unsure whether you meet your state's income limit, submit an application anyway — the state will determine your status based on official rules, not your estimate.
  • Once enrolled, you will receive a Medicaid card in the mail and can use it at any provider who accepts Medicaid in your state.

Finding your state's Medicaid office and application portal

The fastest way to find your state's Medicaid program is to visit Medicaid.gov and click on your state's name. The federal site will direct you to your state's portal, phone number, and mailing address. Each state names its program differently — some call it Medicaid, others use names like MassHealth, BadgerCare, or Peach Care — but Medicaid.gov has a complete list with links to each one.

If you do not have internet access, call your state's health department main line and ask for the Medicaid enrollment office. They will either enroll you over the phone or mail you a paper application. Some states also have local offices in county health departments where you can apply in person.

What documents you need to bring or upload

Have these items ready before you start your application: a recent pay stub (within the last 30 days), proof of residency (a utility bill, lease, or mortgage statement), your Social Security number or ITIN, and proof of citizenship or immigration status. Citizenship proof can be a birth certificate, passport, or naturalization papers. If you are not a U.S. citizen, you will need to show your immigration documents — some states cover certain non-citizens, others do not.

If you are self-employed or do not have recent pay stubs, bring tax returns from the last year or a letter from your employer stating your income. If you receive unemployment, Social Security, or other benefits, bring a statement showing the monthly amount. The state will ask for these documents either during the online application or afterward by email or mail.

Income limits and how they are calculated

Each state sets its own income limit for Medicaid. Most states cover adults earning up to 138% of the federal poverty line, but some cover less. For 2024, 138% of the poverty line for a single person is roughly $1,800 per month; for a family of three, roughly $3,800 per month. These numbers change each year. Your state's Medicaid website will show the exact limit for your household size.

Income is calculated as your household's total monthly earnings before taxes. This includes wages, self-employment income, unemployment benefits, and Social Security — but not food stamps, housing assistance, or child support you receive. If your income is close to the limit, the state will count deductions like child care costs or medical expenses, which can lower your countable income and make you may be able to access.

Do not guess whether you meet the limit. Submit an application and let the state determine your status. Many people think they earn too much and do not apply, but the state's calculation may be different from yours.

What happens after you submit your application

The state will send you a notice by mail or email within two to four weeks saying whether you are approved, denied, or need to send more information. If they ask for more documents, respond within the deadline they give you — usually 10 to 30 days — or your application may be closed. If you are approved, your Medicaid card will arrive in the mail within one to two weeks. You can use it immediately at any doctor, hospital, or pharmacy that accepts Medicaid in your state.

If you are denied, the notice will explain why and tell you how to appeal. You have the right to request a hearing and present your case. If your income or household situation changes after you enroll, you must report the change to your state's Medicaid office — usually online or by phone — so they can update your coverage.

Medicaid for children and pregnant people

Most states cover children up to age 19 at higher income limits than adults — often 200% or more of the poverty line. Pregnant people are usually covered at the same income limit as other adults, but some states extend coverage for a few months after birth. Children's Health Insurance Program (CHIP) is a separate program for children in families earning too much for Medicaid but not enough to afford private insurance; it works similarly to Medicaid and you apply through the same state office.

If you are pregnant or have children, mention this when you apply. The state may enroll your children in CHIP if they do not meet Medicaid income limits, and you may be covered under a different category than your children.

Medicaid coverage for people over 65 and people with disabilities

If you are 65 or older, you are usually enrolled in Medicare first. Medicaid can cover your Medicare premiums and out-of-pocket costs — this is called Medicaid-Medicare Coordination or "dual coverage." You apply for this through your state's Medicaid office, not Medicare.

If you are under 65 and have a disability, you may be covered through Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Some states automatically enroll SSI recipients in Medicaid; others require a separate application. If you receive SSDI, you become may be able to access for Medicare after two years, but you can also receive Medicaid in some states. Contact your state's Medicaid office to learn which programs you may be covered under.

Frequently Asked Questions

Can I apply for Medicaid if I am not a U.S. citizen?

It depends on your immigration status and your state. Most states cover lawful permanent residents (green card holders) and refugees. Some cover other visa holders. Undocumented immigrants are generally not covered, though a few states cover emergency services only. Bring your immigration documents when you apply and ask your state's Medicaid office which statuses are covered.

What if my income changes after I enroll?

You must report changes to your state's Medicaid office within 30 days. If your income increases above the limit, your coverage will end on a date the state tells you. If your income decreases, you may become may be able to access for more assistance. Most states let you report changes online, by phone, or by mail.

Do I have to pay anything for Medicaid?

Medicaid is free for most people. Some states charge small copays when you visit a doctor or fill a prescription — usually $1 to $5 — but these are rare and cannot be charged for preventive care. You do not pay a monthly premium like you would for private insurance.

How long does Medicaid coverage last?

Medicaid coverage is continuous as long as you remain may be able to access. You do not have to reapply every year like you do for marketplace insurance. However, your state may ask you to verify your income and household size every 12 months. If you do not respond to a verification request, your coverage may end.

Can I use my Medicaid card in another state?

No. Medicaid is state-specific, so your card only works with providers in your state. If you move to another state, you must apply for that state's Medicaid program. If you travel, you can use your coverage for emergency services in other states, but not for routine care.