Medicaid & CHIP coverage

You can still get coverage this year if you qualify for Medicaid or the Children’s Health Insurance Program (CHIP). 
These programs cover individuals and families with limited incomes, disabilities, and some family situations. 
You can apply for these programs any time. If you qualify, you can enroll immediately.

Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Some states have expanded their Medicaid programs to cover all people below certain income levels.

See if you qualify for Medicaid based on income alone

Find out if you qualify for Medicaid based on your income. Enter your household size and state in our savings tool, and we'll tell you if you qualify for Medicaid or savings on a Marketplace plan.

FIND OUT NOW

Even if you don't qualify for Medicaid based on income, you should apply. You may qualify for your state's program, especially if you have children, are pregnant, or have a disability. You can apply for Medicaid any time of year — Medicaid and CHIP do not have Open Enrollment Periods.

Note: Medicaid & CHIP program names vary. Learn what they’re called in your state.

Apply for Medicaid and CHIP 2 ways

1. Through the Health Insurance Marketplace

Fill out an application through the Health Insurance Marketplace.

• If it looks like anyone in your household qualifies for Medicaid or CHIP, we’ll send your information to your state agency. They’ll contact you about enrollment.
• When you submit your Marketplace application, you’ll also find out if you qualify for an individual insurance plan with savings based on your income instead. Plans may be more affordable than you think.

Create an account to start a Marketplace application.

2. Through your state Medicaid agency

You can also apply directly to your state Medicaid agency. Select your state below for your Medicaid agency’s contact information.

       Select Your State                Alabama                Alaska                American Samoa                Arizona                Arkansas                California                Colorado                Connecticut                Delaware                District of Columbia                Florida                Georgia                Guam                Hawaii                Idaho                Illinois                Indiana                Iowa                Kansas                Kentucky                Louisiana                Maine                Maryland                Massachusetts                Michigan                Minnesota                Mississippi                Missouri                Montana                Nebraska                Nevada                New Hampshire                New Jersey                New Mexico                New York                North Carolina                North Dakota                Northern Mariana Islands                Ohio                Oklahoma                Oregon                Pennsylvania                Puerto Rico                Rhode Island                South Carolina                South Dakota                Tennessee                Texas                Utah                Vermont                Virginia                Virgin Islands                Washington                West Virginia                Wisconsin                Wyoming            

Medicaid & CHIP basics

Medicaid basics

Children’s Health Insurance Program (CHIP) basics

More answers: Medicaid & CHIP

If I have Medicaid or CHIP, am I considered “covered” by the health care law?

What services does Medicaid cover?

What’s the income level to qualify for Medicaid?

If my income’s too high for Medicaid, can I buy insurance through the Health Insurance Marketplace?

What if I'm eligible for Medicaid, but want to buy an insurance plan in the Marketplace instead?

What if I have Medicaid now, but I have only limited benefits?

What rules apply to former foster children and Medicaid?

What if I’ve been turned down for Medicaid or CHIP coverage?

Special Enrollment Periods for complex issues

Begin highlighted text

IMPORTANT: Recently impacted by a hurricane or other natural disaster?

If you were qualified to enroll in Marketplace coverage during Open Enrollment or a Special Enrollment Period but were unable to enroll due to a hurricane or other natural disaster, you may be eligible for another Special Enrollment Period. To qualify, you must live (or have lived during the event) in a county that is eligible to apply for "individual assistance" or "public assistance" by the Federal Emergency Management Agency (FEMA). If you are eligible, you have 60 days from the end of the FEMA-designated incident period to complete your enrollment in Marketplace coverage and request a retroactive start date based on when you would have picked a plan if not for the disaster. See the following link for FEMA designation information: https://www.fema.gov/disasters. For help enrolling through this Special Enrollment Period, contact the Marketplace Call Center.

End highlighted text

Outside the Open Enrollment Period, you can enroll in a private health plan through the Marketplace only if you qualify for a Special Enrollment Period.

You can qualify for a Special Enrollment Period if either of the following applies to you:

• You have a qualifying life event like having a baby, getting married, or losing minimal essential coverage. Learn more about Special Enrollment Periods and other coverage options outside Open Enrollment.
• You have other complicated situations, as described on this page.

Other complicated cases that may qualify you for a Special Enrollment Period

Below are cases and examples that may also qualify you for a Special Enrollment Period:

• You experience an exceptional circumstance
• You experience a Marketplace enrollment or plan information display error
• You live or previously lived in a state that hasn’t expanded Medicaid and you become newly eligible for help paying for a Marketplace insurance plan
• You are determined ineligible for Medicaid or CHIP
• You gain or become a dependent due to a child support or other court order
• You experience domestic abuse/violence or spousal abandonment
• You get an appeal decision that’s in your favor

Exceptional circumstance

You faced a serious medical condition or natural disaster that kept you from enrolling. For example:

• An unexpected hospitalization or temporary cognitive disability, or were otherwise incapacitated
• A natural disaster, such as an earthquake, massive flooding, or hurricane

Enrollment or plan information display errors

• Misinformation, misrepresentation, misconduct, or inaction of someone working in an official capacity to help you enroll (like an insurance company, navigator, certified application counselor, or agent or broker) kept you from:
  • Enrolling in a plan
  • Enrolling in the right plan
  • Getting the premium tax credit or cost-sharing reduction you were eligible for
• A technical error occurred when you applied on HealthCare.gov -- you probably saw an error message when completing your application – that prevented:
  • You from enrolling in a plan, or
  • Your health insurance company from receiving your enrollment information
• The wrong plan data was displayed on HealthCare.gov at the time that you selected your health plan, such as benefit or cost-sharing information.

Becoming newly eligible for help paying for a Marketplace insurance plan during or after living in a state that hasn’t expanded Medicaid

You previously lived in a state that hasn’t expanded Medicaid and weren’t eligible for Medicaid or advance payments of the premium tax credit (APTC) because your income was too low. But in the last 60 days, you had an increase in household income or moved, making you newly eligible for premium tax credits.

Being determined ineligible for Medicaid or CHIP

You applied for Medicaid or CHIP during the Marketplace Open Enrollment Period and your state Medicaid or CHIP agency determined that you weren’t eligible for Medicaid or CHIP after Open Enrollment ended. You may qualify for a Special Enrollment Period regardless of whether you applied through:

• The Marketplace and your information was sent to your state Medicaid or CHIP agency, or
• Your state Medicaid or CHIP agency directly

Gaining or becoming a dependent due to a child support or other court order

You gained a new dependent or became a dependent of someone else due to a court order. Your coverage would start the effective date of the court order – even if you enroll in the plan up to 60 days afterward.

Having experienced domestic abuse/violence or spousal abandonment

You're a survivor of domestic abuse/violence or spousal abandonment and want to enroll in your own health plan separate from your abuser or abandoner. You can enroll by contacting the Marketplace Call Center. Your dependents may be eligible too.

If you’re married to your abuser/abandoner, you can answer on your Marketplace application that you’re unmarried, without fear of penalty for mis-stating your marital status. You then become eligible for a premium tax credit and other savings on a Marketplace plan, if you qualify based on your income.

If you qualify for this SEP, you'll have 60 days to enroll in a Marketplace plan.

Prevailing on an appeal

You believe you received an incorrect eligibility determination or an incorrect coverage effective date and file an appeal with the Marketplace. If the ruling goes in your favor, you’ll be given the option to enroll in or change plans either retroactively or prospectively.

If you think you qualify for a Special Enrollment Period

If you think you qualify for a Special Enrollment Period for one of the situations listed on this page, contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325)

The representative will ask for information about your situation to determine if your circumstances qualify you for a Special Enrollment Period. The representative will help you apply and enroll in coverage.

If you’re already enrolled in a plan and you get a Special Enrollment Period, you can stay in your current plan in most cases, or you can switch plans. In some limited cases, you may qualify for an earlier effective date of coverage. Remember, you must make the first premium payment before your coverage becomes effective.

Filing an appeal

If your request for a Special Enrollment Period is denied, you can file an appeal. If the denial is found incorrect, you can get coverage back to the date your Special Enrollment Period was denied.

How to file an appeal:

• Select your state’s appeal form, download it, and fill it out
• Mail your appeal to:
  
  Health Insurance Marketplace
  Attn: Appeals
  465 Industrial Blvd.
  London, KY 40750-0061

When possible, include a copy of any eligibility determination notice or other official notice you received. This isn’t required, but will help us process your appeal.

When mailing the appeal request to the Health Insurance Marketplace, be sure to include the last 4 digits of the London, KY ZIP code (40750-0061). This will help your appeal arrive faster.