Medicaid Application - Applying for Medicaid

Unlike other programs, Medicaid does not have an open enrollment period. Once you find out if you are eligible for Medicaid you can apply for coverage all-year-round via HealthCare.gov or through your state's Medicaid agency website. You can apply for Medicaid through the Marketplace website, your state's local agency or via telephone with the information below.

Applying for Medicaid through the Healthcare.gov Marketplace may be the quickest and most straight forward path for you. The process will also be beneficial to those who are interested in finding out if you or any of your dependents qualify for CHIP (Children's Health Insurance Program) or an individual Marketplace insurance program with savings. Once you submit your application it will notify your state of your qualification opportunities, the state will then notify you. 

You must first Create an Account on the HealthCare.gov website using your credentials. After you create an account you then fill out and submit your application. 

In order to complete your application, you will need to provide certain documentation to show you meet the requirements. These items may include:

• Medical Records (proof of disability, if applicable)
• Bank Statements (proof of income)
• Pay Stubs or Tax Return (must be recent pay stubs and/or most recent tax return)
• Drivers License or Birth Certificate (proof of age and citizenship)
• One of - Mortgage documents, Utility Bills, Lease (proof of address)

If you decide to go through the HealthCare.gov Marketplace and qualify for coverage, the government will contact your state which will then contact you regarding enrollment. If you qualify for Medicaid, your coverage will be retroactive back to the original date of application. Depending on your state, your coverage may also be retroactive for up to three months prior to application date.

It generally takes up to 45 days to process your application, though it can take up to 90 days to process the application if it is tied to disability.

You may also call the HealthCare.gov Marketplace call center to apply for coverage at 1-800-318-2596. TTY users can call 1-855-889-4325.

Most states also have the option to apply for Medicaid through their individual state programs. These programs are still Medicaid, though may be named differently. The process is quite similar to the online application requiring the same documents and verifications. 

You must be a resident of the state of which you are applying for benefits. The application process generally takes around the same time as applying through the Marketplace and you will be notified of approval or denial in the same way, via a letter through mail.

Although some states may vary, the majority of states will require the same documentation and verification when applying as the HealthCare.gov Marketplace does. Examples of documentation include:

• Medical Records (proof of disability, if applicable)
• Bank Statements (proof of income)
• Pay Stubs or Tax Return (must be recent pay stubs and/or most recent tax return)
• Drivers License or Birth Certificate (proof of age and citizenship)
• One of - Mortgage documents, Utility Bills, Lease (proof of address)

All the states and their respective websites for Medicaid applications are listed in the table below. 

If you were denied Medicaid coverage for any reason you may still be able to receive subsidized heath insurance using the HealthCare.gov Marketplace. Though unlike Medicaid, other programs are not available for enrollment at all times throughout the year. Normal open enrollment for other programs is held from November 1st through December 15th. However, you may qualify for a Special Enrollment Period for a program if you have had one of several applicable life-changing events recently. These examples may include, but are not limited to:

• Loss of health coverage - Recently turned 26 and are no longer on parent's coverage.
• Changes in household - Married or divorced. Having a baby or adopting a child. Death in family.
• Changes in residence - Seasonal worker moving to/from temporary residence. Student moving to/from school. Moving to a different country or zip code.
• Other Examples - Changes in income affecting previous coverage. New U.S. Citizenship. Recently released from incarceration. AmeriCorps starting/ending service.

Your Medicaid application may have been denied for a number of common reasons: 

• Missing documentation
• Clerical error made by applicant
• Clerical error made by caseworker
• Missing pertinent information

Federal law requires the state must issue a denial notice within 45 days of the original application date if the application was not based on a disability, and within 90 days of the application date if the application was based on a disability.

If your Medicaid application is denied you will receive a letter in the mail stating the reason for the denial and information on how to appeal the decision. It's quite common for applications to be denied due to clerical errors and other issues, so if your application was denied make sure to read the reasoning carefully to understand any mistakes that may have been made. If you found a clerical issue with your Medicaid application made either by yourself or your caseworker, there are a couple options for you to consider. 

You can request a Medicaid denial reversal. This route is considerably less formal than an appeal and simply means to contact your caseworker to discuss and resolve the issue. This is by far the fastest and easiest option when fixing an application issue.

If your Medicaid application was denied for financial reasons, including if your income was too high at the time of application or your spend-down limit was not met, you are able to re-apply for the program at any time.

If you received a letter stating your Medicaid application has been denied, it will also contain clear information as to why the denial was made and how to appeal the decision. As stated above, most cases will be denied from a clerical error or similar issue. Though if your Medicaid was denied due to an issue that cannot be resolved by either a denial reversal or conversation with your caseworker, you can submit to appeal the decision.

The appeal process will take place in three parts:

Request an Appeal:

Once you receive the Medicaid denial letter, you have 45 days to submit for an appeal. In some cases there may be a 30-90 day time period allowed if the case is tied to a disability. The letter you receive will tell you how long you have to submit an appeal for your specific case. It will also contain instructions on how to submit an appeal in your state. In some cases the state may require you to request an appeal in writing, though this varies depending on your state's rules. Whether a written appeal request is necessary or not will be noted in your denial letter.

Appeals Hearing:

Once you request an appeal hearing, the Medicaid office will then schedule a date for the hearing and provide details and the next steps of the process. It's a good idea to retain an attorney for the hearing if at all possible, though you can also seek to have a Medicaid Planning Professional alongside you. You can follow the steps here if you are interested in this option. It is imperative that you appear for your appeal hearing. If you do not, the case will be dismissed entirely.

Appeals Hearing Results:

After the hearing you will be notified by mail of the decision to either approve or deny your appeal. If your appeal was denied it will contain information on how to appeal the hearing officers decision. In most cases, if your appeal is approved your coverage will be retroactive from the original date of application.