How to Apply for Medicaid: A Step-by-Step Guide
Medicaid is a government healthcare program that provides low-cost or free medical coverage to eligible individuals and families. Many people who qualify for Medicaid don’t realize they’re eligible, making it essential to check your status and apply.
Medicaid covers essential health services, including doctor visits, hospital stays, mental health services, preventive care, and prescriptions. At Nest Health, we make healthcare more accessible by offering in-home and virtual care for families on Medicaid. This guide will walk you through how to apply for Medicaid and what to expect throughout the process.
Medicaid is run by each state, so eligibility rules and the application portal can look a little different depending on where you live. If you want the exact steps for your state, start with your state Medicaid agency — then use this guide for documents, timelines, and what to expect after you apply.
How to Apply for Medicaid (Quick Step-by-Step Guide)
Here’s the basic process to apply for Medicaid. The sections below will break each step down in more detail.
Check your eligibility.
Review your state’s Medicaid requirements and see whether your household may qualify based on income, size, and special circumstances.
Gather your required documents.
Collect proof of identity, income, residency, Social Security numbers, and any other documents your state requests.
Submit your Medicaid application.
Apply online, by phone, in person, or by mail through your state Medicaid agency.
Stay on top of follow-ups and ongoing requirements.
Watch for notices from your state asking for more information, and respond quickly to avoid delays or denials.
Appeal a decision if you’re denied.
If you believe your application was denied incorrectly, you can request an appeal or a fair hearing through your state.
Report changes after you’re enrolled.
Let your state know if your income, household size, address, or insurance changes so your coverage stays accurate.
What Is Medicaid?
Medicaid is a joint federal and state program that provides healthcare coverage for low-income individuals and families. Eligibility and benefits vary by state, so it’s important to check your state’s specific requirements using the Medicaid.gov eligibility tool.
Common Medicaid eligibility factors include:
Income level (based on Federal Poverty Guidelines)
Household size and number of dependents
Special circumstances, such as pregnancy, disability, or chronic conditions
Medicaid is different from Medicare, which primarily covers individuals 65 and older and certain people with disabilities.
Who Medicaid Typically Covers
Across states, Medicaid most often provides coverage for:
Children and teens
Pregnant people
Low-income adults (eligibility varies by state)
Parents or caregivers of children
Adults age 65 and older
People with disabilities or certain chronic conditions
Even if you’re unsure whether you qualify, it’s worth applying — many families are eligible and don’t realize it.
Preparing to Apply for Medicaid
Having the right documents ready before applying helps avoid delays. Required documents may include:
Proof of identity (driver’s license, birth certificate, passport)
Social Security numbers for all applicants
Proof of income (pay stubs, tax returns, benefit statements)
Proof of residency (utility bill, lease agreement, mortgage statement)
Information about other health insurance (if applicable)
Check your state’s Medicaid website for specific documentation requirements.
| Group | Medicaid often covers | Notes |
|---|---|---|
| Children & teens | Full medical coverage |
If family income is too high → CHIP |
| Pregnant people | Prenatal + postpartum care | Coverage length varies by state |
| Low-income adults | Coverage in many states | Depends on Medicaid expansion |
| Parents/caregivers | Coverage if income eligible | Varies by state |
| 65+ adults | Long-term + medical support | Often with Medicare |
| Disabilities/chronic conditions | Medical + support services | State rules apply |
A quick note on Medicaid expansion:
Some states have expanded Medicaid, which allows more low-income adults to qualify based primarily on income. In states that haven’t expanded, adult eligibility may depend more on specific categories (like pregnancy or disability). Because of this, the best next step is always to confirm your state’s rules before applying.
Preparing to Apply for Medicaid
Having the right documents ready before applying helps avoid delays. Required documents may include:
Proof of identity (driver’s license, birth certificate, passport)
Social Security numbers for all applicants
Proof of income (pay stubs, tax returns, benefit statements)
Proof of residency (utility bill, lease agreement, mortgage statement)
Information about other health insurance (if applicable)
Check your state’s Medicaid website for specific documentation requirements.
Medicaid Application Methods
There are four ways to apply for Medicaid:
| Application method | Brief explanation (what to expect) | Useful links / next steps |
|---|---|---|
| 💻 Online | Usually the fastest option. You’ll complete a digital form and upload documents directly. Great if you have steady internet and your paperwork handy. | State Medicaid application portal (state selector on Medicaid.gov) ; Apply via HealthCare.gov if you’re not sure whether you qualify. |
| 📞 By phone | A state Medicaid rep or enrollment helper can walk you through the application and tell you exactly what documents to send. Helpful for complex situations or language support. | State Medicaid contact list (phone numbers by state) ; HealthCare.gov “Find Local Help” for phone assisters. |
| 🧑🏿🤝🧑🏻 In person | You apply with a caseworker or assister at a local office or enrollment center. Best if you want hands-on help or need to confirm documents. | Local Medicaid office locator via your state agency; HealthCare.gov “Find Local Help” tool for nearby assisters. |
| 📮 By mail (or fax/drop-off in some states) | You print a paper form, fill it out, and send it with copies of documents. Slower, but useful if internet access is limited. Some states accept fax or drop-off. | Download paper application from your state Medicaid site ; Call your state office to confirm mailing/fax/drop-off details. |
💡Tip: Online applications are processed faster than mail-in applications.
What You Need to Know About Filling Out the Medicaid Application
Filling out your application accurately is crucial to avoid delays. Expect to provide information on:
🪪 Personal details (name, address, Social Security number)
🏡 Household members and their relationships
💰 Income sources (employment, benefits, other earnings)
🍎 Current health insurance coverage (if applicable)
🔎 Review all details carefully before submitting your application.
When Should You Apply for Medicaid?
Medicaid enrollment is open year-round, so you can apply anytime. However, apply immediately if:
You are pregnant or have a child who needs care.
You recently lost health coverage.
You need urgent medical services and may qualify for retroactive coverage (varies by state).
If your child doesn’t qualify for Medicaid, CHIP may help
The Children’s Health Insurance Program (CHIP) offers low-cost health coverage for children in families who earn too much to qualify for Medicaid. CHIP is also run by each state, and you can usually apply through the same state agency or application portal.
If you’re denied or don’t qualify
If your income is too high for Medicaid, you may still qualify for affordable coverage through the Health Insurance Marketplace. In many cases, being denied Medicaid or losing Medicaid coverage can open a Special Enrollment Period so you can enroll in a Marketplace plan.
What to Expect After You Apply
After submitting your application:
Processing typically takes 30-45 days.
Watch for notices via mail or email requesting additional documents.
If approved, you’ll receive:
An approval letter confirming your benefits.
A Medicaid insurance card (arrives by mail).
If denied, you have the right to appeal—follow your state’s appeal process.
Common Reasons Applications are Denied (And What to Do Next)
Applications are often denied for reasons that can be fixed, such as:
Missing documents or incomplete information
Income or household details that don’t match state records
Residency verification issues
Not responding to a follow-up request on time
If you’re denied, you can usually:
1. Submit missing documents or corrections
2. Reapply if needed
3. Request an appeal or fair hearing through your state if you believe the decision was incorrect
What Services Are Covered Under Medicaid?
Medicaid covers a wide range of healthcare services, including:
Primary care visits and specialist appointments
Hospitalizations and emergency care
Preventive care (vaccinations, screenings, well-child visits)
Mental health and behavioral health services
Prescription medications
To find a Medicaid-approved provider, check your state’s Medicaid website. Nest Health offers in-home and virtual care for eligible families on Medicaid, making healthcare easier to access.*
Do You Have to Renew Your Medicaid Membership?
Yes, Medicaid coverage must be renewed annually. Stay informed by:
Watching for renewal notices from your state.
Updating any changes in income or household information.
Submitting renewal forms on time to avoid losing coverage.
Failing to renew on time could mean a gap in coverage, requiring you to reapply.
Get the Healthcare You Need with Nest Health
Medicaid ensures families have access to essential healthcare, but finding the right care can still be challenging. Nest Health brings quality healthcare directly to families on select participating health plans, offering:
✔ In-home primary and pediatric care
✔ Telehealth visits for medical and mental health needs
✔ Comprehensive family-focused care
