Applying for Medicaid: A Step-by-Step Guide
- Medicaid can be applied for directly or through your state's online exchange. Find out what the requirements are to apply and who to contact for help.
Medicaid is the joint federal and state health insurance program for people with qualifying income and assets. Seniors with limited or low income can apply for Medicaid on its own to help pay for basic medical care or as a supplement that helps cover the extra costs Medicare leaves uncovered.
Each state administers its own Medicaid program, so terms and requirements for participation vary somewhat depending on location. As always, it's helpful to consult with a certified senior planner or benefits consultant before adding the Medicaid program to your comprehensive health coverage.
How to Apply for Medicaid
It is possible to apply for Medicaid through the benefits specialist at most hospitals and other health facilities, since the program is usually able to pay for medical costs already incurred. Most applicants, however, apply for Medicaid in one of two ways: directly or through an exchange.
Apply Directly With a State Medicaid Program
The most direct way to apply for Medicaid is to contact a state office directly and put in an application. This often requires a brief meeting with a benefits counselor or case worker to establish eligibility for the program. Some states take Medicaid applications online, while others require an in-person visit to a Social Security Administration (SSA) office.
In many states, applications for Medicaid can be taken at county Human Services offices. Seniors with limited ability to travel or manage their affairs may apply for Medicaid through an authorized representative, including the benefits coordinator at a residential care facility.
Apply Through Healthcare.gov
Many seniors apply for Medicaid online through Healthcare.gov, or through a state health insurance exchange. Not all states offer this service, and many still require proof of eligibility to be mailed.
Applying online through an exchange can be helpful for seniors with complex health coverage and insurance needs, as these exchanges often allow for easy comparisons across multiple plan types, including private issuers.
Medicaid Eligibility Requirements
State Medicaid programs require all applicants to be U.S. citizens or permanent legal residents and to live in the state where they apply for Medicaid. Beyond that, many states require Medicaid applicants to have a diagnosed medical need for care, along with meeting income and asset limits. Medical needs can include chronic medical conditions and various disabilities. Some states also automatically authorize Medicaid for children and pregnant women.
All states’ Medicaid programs impose maximum income and asset thresholds, though they do not all use the same standards. In states with a high overall cost of living, the maximum income allowed for Medicaid applicants tends to be higher than in less expensive states.
All Medicaid programs use the Federal Benefit Rate as a baseline, and then some raise the threshold by a fixed percentage. In 2020, the Federal Benefit Rate for a single adult is $9,396 a year. Married couples may earn up to $14,100 a year and still qualify for all means-tested benefits, including Medicaid.
Seniors whose income is above the Federal Benefit Rate can still apply for Medicaid. In most cases, states allow applicants to earn up to 300% of the federal government’s guidelines, though a progressively higher share of cost may be imposed as a condition of receiving benefits through Medicaid health plans.
Applicants who currently receive SSI/SSDI, nutrition assistance through SNAP, low-income housing aid or any of several other federal assistance programs are automatically eligible for Medicaid in most states.