The Affordable Act gives states the option to expand their Medicaid program. People with incomes just over $16,000 can qualify in states that have expanded Medicaid. If you think you may be eligible for Medicaid, it's a good idea to apply. While the rules are different from state to state, the basic process for signing up is similar.
1. Go to Healthcare.gov
Healthcare.gov is not just for buying a private plan. You can also find out if you qualify for Medicaid. You will be asked a series of questions regarding your monthly income, your family size, and where you live. Based on your answers, healthcare.gov will let you know whether or not you may qualify for Medicaid.
2. Fill out the application.
If your state is running its own Marketplace, healthcare.gov will automatically redirect you to your state’s website to start an application. Otherwise, you can start an application on healthcare.gov that will automatically be forwarded to your state’s Medicaid office for a determination on whether or not you qualify. You can apply for Medicaid and CHIP any time of year, not just during Marketplace Open Enrollment.
You can download and print the form from your state's Medicaid website. You can also get it in the mail by calling 877-267-2323.
3. Gather up documentation. Your state will need to see some personal and financial information to make sure you are eligible. The specifics vary from state to state. But you might need to submit:
- A tax bill for your home
- A copy of your birth certificate
- A pay stub to prove how much you earn
- Bank statements
- Your Social Security number
- Other personal information
Double check the list to make sure you have everything you need.
If you have a disability, it can take longer to process your application. You may have to wait up to 90 days.
You may also have to wait longer if you don’t get all the paperwork in on time. Try to provide everything promptly. If you don’t meet the deadlines or don’t provide what is needed, Medicaid may reject your application. Then you'll have to apply all over again.
After the Decision: Next Steps
If you are denied, Medicaid will send a letter explaining why. If you disagree, the letter will also tell you how to appeal the decision.
If you are found to be eligible, you'll get a letter telling you when your coverage starts. You may have to choose a Medicaid health plan at this time if your state uses private plans to provide benefits. If you do not chose a health plan within a certain timeframe, you will be assigned one. So if you have a doctor or clinic you like to use, make sure you choose a health plan with it in the network. Once you chose one, you will get an ID card from the health plan. In some states you'll also get a separate Medicaid card. To use your Medicaid benefits, always carry both cards with you and use them when paying for health care, such as for medications or doctor's appointments. Check to make sure your doctor, hospital, and pharmacy accept Medicaid or are in your Medicaid health plan’s network before making appointments or picking up prescriptions.
Keep in mind that even after you are found to be eligible, Medicaid will review your case regularly. You may have to submit more financial information. If your circumstances change -- for instance, if your income goes up -- you may lose your Medicaid eligibility. You may then be able to buy a private insurance plan through your state’s marketplace even if it’s not during the annual open enrollment period.