How to Apply for Medicaid

Medicaid has no open enrollment window. HealthCare.gov states plainly that you can apply for, or re-enrol in, Medicaid or CHIP any time of year. So the date on the calendar is never a reason to wait.

Apply even if you are unsure you qualify. Apply even if a bill has already arrived. Apply even if someone told you years ago that you earned too much — your income, your household size, and your state's rules may all have changed since.

Door one: your state Medicaid agency. Every state runs its own program inside federal rules, so every state has its own application, its own phone number, and sometimes its own name for the program. California's is Medi-Cal. Medicaid.gov keeps the full state-by-state directory of agency links and phone numbers under "Where can people get help with Medicaid and CHIP." That page is the fastest way to reach a human who can tell you your state's actual income limits.

Door two: one application at HealthCare.gov. Fill out a single Marketplace application. If it looks like anyone in your household may qualify, HealthCare.gov securely forwards your information to your state agency and the state finishes the job. The Marketplace Call Center is 1-800-318-2596, TTY 1-855-889-4325, open 24 hours a day, 7 days a week except holidays.

If you are already in treatment, use both doors. Call your state agency, and ask your hospital's financial counselor to file for you the same week.

Federal law forces every state to cover some groups — low-income families, qualified pregnant women and children, and people receiving Supplemental Security Income (SSI). Above that floor, states choose, so there is no single national income cut-off you can look up.

For most adults under 65, eligibility is worked out using MAGI, or modified adjusted gross income. MAGI looks at taxable income and tax filing relationships. It does not count your savings or your car. Medicaid.gov says states "were given the option to extend eligibility to adults with income at or below 133% of the FPL," and that most states have chosen to expand. If your state did not expand, an adult with no children may be turned down at a far lower income.

If you are 65 or older, blind, or have a disability, a different set of rules applies, and those pathways usually do count assets as well as income.

Two routes matter especially if your income looks too high on paper:

• Medically needy, or spend-down. Medicaid.gov says medically needy individuals "can still become eligible by 'spending down' the amount of income that is above a state's medically needy income standard" by incurring medical expenses they have no insurance for. Cancer bills are precisely the kind of expense that does this. Not every state has a medically needy program — ask yours.
• The breast and cervical cancer pathway. A separate Medicaid group covers people under 65 who need treatment for breast or cervical cancer after screening through the CDC's program, with no income or resource test at all.

Requirements vary, so check your own state's list first. Most states will ask for some combination of:

• Proof of income — recent pay stubs, a benefits award letter, or last year's tax return
• Proof of identity and citizenship or qualified immigration status
• Proof of where you live, such as a lease or a utility bill
• Who is in your household, and how you file taxes
• Social Security numbers for the people applying
• For asset-based pathways, recent bank and retirement account statements

Missing one document is not a reason to delay. File the application, then send what is missing.

This is the step people skip. Medicaid.gov states that "benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period."

That can mean a biopsy, a scan, or a hospital stay that already happened gets paid. Some states have changed the rules for some groups, so ask your caseworker directly: which months can be covered for me, and what do I need to send? Then hold any bills from that window rather than paying them.

None of the following charges you:

• Marketplace Navigators and certified assisters — search by ZIP code at localhelp.healthcare.gov, or ask the call center to find one.
• Your hospital's financial counselor or oncology social worker. Ask at the front desk on your next visit; this is their job.
• Patient Advocate Foundation, (800) 532-5274, for one-to-one case management on coverage and bills.
• Triage Cancer, 424-258-4628, which publishes state-by-state guides to insurance and benefits.

If your application is denied, ask for the decision in writing with the reason. You have the right to appeal and to a state fair hearing, and the denial letter must tell you the deadline. Missing that deadline is much harder to fix than filing the appeal, so put the date on your fridge the day the letter arrives.

• Medicaid.gov — Eligibility Policy
• HealthCare.gov — How to apply for Medicaid and CHIP
• Medicaid.gov — Where Can People Get Help With Medicaid & CHIP?