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Start with a HealthCare.gov application or Medicaid and CHIP screening. It can check whether household members may qualify for Medicaid or the Children’s Health Insurance Program (CHIP), and whether others may qualify for savings on Marketplace coverage. For a final Medicaid eligibility decision, contact your state Medicaid agency or complete its application process: state rules and personal circumstances determine the outcome.
Choose where to check eligibility
Medicaid and CHIP are administered by states, so eligibility depends on where you live as well as details such as income, household size, age, pregnancy, disability, and family circumstances. Medicaid.gov says to contact your state Medicaid agency to find out for sure whether you qualify.
- HealthCare.gov: Apply through the Marketplace to have your information screened for potential Medicaid or CHIP eligibility and Marketplace savings. If someone appears eligible for Medicaid or CHIP, the state agency may contact them.
- Your state Medicaid agency: Apply directly or follow up with the agency for a state determination. Find your agency through Medicaid.gov’s state directory.
You can apply for Medicaid or CHIP at any time of year. An online estimate or screening result is not a final state Medicaid decision.
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Gather the information requested by the application so it can assess each person in the household. HealthCare.gov’s Marketplace application form lists information applicants may need, including:
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- Names and details for household members, including who lives with you and who is included in the application.
- Current monthly income and expected income for the coverage year, along with employer and job-based coverage information.
- Current insurance policy numbers, if applicable.
- Social Security numbers or eligible immigration document numbers, when requested.
Marketplace savings are based on expected household income for the year you want coverage. Use your best estimate, and report changes in income or household circumstances so the application remains accurate. An inaccurate income estimate can affect the amount of premium tax credit you receive and may lead to repayment when you reconcile it on your tax return.
Submit an application and review the result
- Identify the state where you live. State rules affect Medicaid and CHIP decisions.
- Apply through HealthCare.gov or your state Medicaid agency. A Marketplace application can screen household members for more than one program; applying directly through the state is another route.
- Get free application help if needed. HealthCare.gov offers online, phone, and in-person assistance. The Marketplace Call Center number listed on the application form is 1-800-318-2596; TTY users can call 1-855-889-4325.
- Read the eligibility notice and complete any follow-up requests. The application may ask you to provide more information. Follow the notice’s instructions and contact the agency or Marketplace if the result is unclear.
One application can produce different results for different household members. For example, an adult may receive a Marketplace result while a child is referred for Medicaid or CHIP review.
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Understand why a simple income cutoff may not answer the question
Medicaid eligibility uses different rules for different groups
For many children, pregnant people, parents, and adults, states use Modified Adjusted Gross Income (MAGI) rules. MAGI considers taxable income and tax-filing relationships; it does not use an asset or resource test for these categories. People who are 65 or older, blind, or have a disability generally use different, SSI-related income methodologies, so the MAGI rule should not be assumed to apply to them. Some states also have medically needy or spenddown pathways; ask your state agency whether one is available if you have substantial medical expenses and income above ordinary limits. These categories and methods are described in the Medicaid eligibility policy overview.
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Expansion status affects some adults, but is not a personal eligibility verdict
In states that expanded Medicaid, HealthCare.gov describes the adult income limit as below 133% of the federal poverty level, effectively 138% after the calculation; a few states use a different limit. That broad description is not a guaranteed threshold for an individual applicant. In states that have not expanded Medicaid, some adults with income below the poverty level may fall into a coverage gap if they do not qualify under another category. Children, pregnancy, disability, and other circumstances can change the assessment, so apply rather than relying on an income guess. See HealthCare.gov’s Medicaid expansion explanation.
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Children may qualify for CHIP when family income is above Medicaid limits
CHIP covers eligible uninsured children under state-specific rules. The Centers for Medicare & Medicaid Services reports that state CHIP eligibility levels range from 170% to 400% of the federal poverty level; that is a span across states, not a universal threshold for a particular child. Include children in the household application so the state can assess them for Medicaid or CHIP. See CMS’s CHIP eligibility and enrollment information.
If Medicaid or CHIP denies coverage, check Marketplace savings
If the state denies Medicaid or CHIP, submit or update a HealthCare.gov application to check whether the affected person qualifies for a Marketplace plan and financial assistance. You do not need to wait for a Marketplace letter before checking your options. Eligibility for premium tax credits depends on the applicable rules and household information, including expected coverage-year income. See HealthCare.gov’s guidance for people who lose or are denied Medicaid or CHIP.
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People eligible for full-benefit Medicaid generally cannot receive Marketplace savings for coverage. Limited-benefit Medicaid can be treated differently, so confirm the type of coverage with the state and check the Marketplace result. HealthCare.gov explains this distinction in its Medicaid and Marketplace coverage guidance.
Compare the actual options for each person
When more than one coverage route is possible, compare the official decision and terms for each household member rather than assuming everyone has the same eligibility or plan.
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| What to compare | What to confirm |
|---|---|
| Program and administrator | Whether the result is Medicaid, CHIP, or a Marketplace plan; identify the state agency or private insurer responsible for coverage. |
| Premium and savings | Whether a premium tax credit applies and what the final monthly premium is for the selected plan. |
| Benefits and out-of-pocket costs | Check the state’s Medicaid or CHIP terms and the Marketplace plan’s benefits, cost sharing, and provider network. CHIP commonly covers checkups, immunizations, doctor visits, prescriptions, dental and vision care, hospital care, laboratory services, emergency care, and behavioral health services; details vary by state. |
| Effective date and continuity | Confirm the coverage start date with the state or plan. Federal Medicaid policy says coverage is effective on the application date or the first day of that month after eligibility is established; retroactive coverage of up to three months may be available if the person was eligible during that period. Ask the state how the policy applies to your case. |
| Household members | Review each person’s notice: a child may qualify for CHIP while an adult receives a Medicaid or Marketplace result. |
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