Medicaid and CHIP: Frequently Asked Questions

No. We are an independent, privately run educational site. We are not affiliated with Medicaid.gov, CMS, or any state Medicaid agency, and we do not process applications or make eligibility determinations. Always apply directly through your state Medicaid agency or Healthcare.gov.

Medicaid is a joint federal-state program based mainly on income and household size, available to eligible people of any age. Medicare is a federal program based mainly on age (65 and up) or certain disabilities, and is not income-based. Some people qualify for both, called being 'dual eligible.'

It depends heavily on your state. In states that adopted Medicaid expansion, adults generally may qualify with household income up to around 138% of the federal poverty level. In non-expansion states, the income limits for adults without dependent children are typically much lower, or coverage may not exist for that group at all. Check your specific state's current limits before assuming either way.

The Children's Health Insurance Program (CHIP) covers children in households whose income is too high to qualify for Medicaid but who still can't easily afford private coverage. Each state sets its own CHIP income limits, and in many states, CHIP is administered together with Medicaid so families apply through the same portal.

The ACA marketplace at Healthcare.gov is the main alternative, offering subsidized private insurance based on your income. Many people just above the Medicaid line qualify for significant premium tax credits on marketplace plans, so it's worth checking even if Medicaid isn't available to you.

Typically proof of identity, proof of income for your household (pay stubs or a tax return), proof of state residency, Social Security numbers, and immigration documentation where relevant. Exact requirements vary by state, so check your state Medicaid agency's application checklist directly.

It means your state needs additional documents or clarification before it can finish processing your application — it is not a denial. These notices have a response deadline, often 10 to 30 days depending on the state, and missing that window can result in your application being closed.

You have the right to appeal, usually within a specific number of days stated on the denial notice. The notice should explain the reason for denial and how to request a fair hearing. Many denials trace back to missing documents or a household size or income figure that doesn't match what the state has on file, which can sometimes be resolved without a full appeal.

This usually happens during redetermination (also called renewal), when a renewal notice is mailed and the response deadline is missed — often because the notice went to an old address. States are required to periodically re-verify eligibility, and not responding can end coverage even if you're still eligible.

No. Medicaid, CHIP, and the ACA marketplace are US programs, and everything on this site describes US federal and state rules specifically. Other countries have entirely different public health coverage systems, and none of the figures or programs discussed here apply outside the US.

You typically apply once through Healthcare.gov or your state's own marketplace, and the system checks whether your household appears to qualify for Medicaid, CHIP, or subsidized marketplace coverage based on the income and household information you provide. You generally can't be enrolled in both a subsidized marketplace plan and Medicaid at the same time.

Your state Medicaid agency, community health centers, and certified marketplace navigators funded to help with Healthcare.gov applications all offer free assistance. You should never have to pay anyone to apply for Medicaid or CHIP, or to get basic guidance on eligibility.