Medicaid Frequently Asked Questions

  1. Will all my medical expenses be covered under Medicaid?

    No, Medicaid does not cover all medical expenses. The medical payments covered by Medicaid vary by state, as it is a federally mandated state-run program. Federal law outlines the mandatory benefits that state Medicaid programs are required to provide, as well as optional benefits states may offer through their program. These optional benefits include coverage of prescription drugs, certain specialist services, vision services and hospice care. Medicaid will only pay medical expenses that are covered under the particular policy’s benefits.

  2. What additional benefits does Medicaid offer?

    The benefits Medicaid programs offer are different in every state. Federal law requires that states offer certain benefits, but it allows states optional benefits that they may choose to include in their policy, such as behavioral health and private nursing services. States also have the option to provide a program for those considered medically needy but not eligible for Medicaid. Under this program, eligible individuals with significant health needs who have spent the difference between their income and the state’s required income level become eligible for Medicaid coverage.

  3. How long will it take to complete a Medicaid application?

    Medicaid applications do not take much time to fill out. Most people complete their state’s Medicaid application in about 30 minutes. Some applications may take longer, depending on the application method chosen. States are required to provide several ways for petitioners to apply for Medicaid. In most states, you can apply for Medicaid online, by mail, over the phone or in person with a local Marketplace Health Navigator.

  4. I submitted my Medicaid application. What happens next?

    After submitting a Medicaid application, the next step is to wait for the decision on your case. Determination of an applicant’s eligibility takes about 45 days from the date when the application was submitted. Applications for children and pregnant women are processed within 30 days of submission. Evaluation of applications for disabled individuals may take as long as 90 days to process. Incomplete applications and submissions that are missing any required documents will take longer to be resolved. When a decision is made, a notification letter is sent to the applicant with information on his or her approval or denial.

  5. What can I do if my Medicaid application is denied?

    When a decision is made on an application, state Medicaid agencies must issue the applicant a written notice detailing the outcome. If a Medicaid claim is denied, the applicant can appeal the decision. The denial notice sent to the applicant contains the appeal deadline date for that application. Appeals must be submitted before the deadline listed on the denial notice. Appeals are then granted a fair hearing that the applicant must attend either in person or by phone. Individuals who do not show up for their hearing risk having their case denied.

  6. Is there a certain time of year when I can apply for Medicaid and CHIP?

    Unlike the Health Insurance Marketplace, Medicaid and CHIP applications do not have open enrollment periods. Those who believe they are eligible for Medicaid and CHIP can submit an application at any point during the year. Individuals who are not sure if they are eligible for Medicaid are encouraged to apply, as they may qualify for their state’s program.

  7. When do I need to renew my Medicaid or CHIP coverage?

    Beneficiaries enrolled in either Medicaid or CHIP must reapply for coverage once a year. Renewal applications should be submitted at the beginning of the last month of coverage for the current year. State agencies remind Medicaid and CHIP recipients of their renewal period by mail. The letter sent usually includes a form that can be submitted via mail, and outlines other methods for application renewal and which documents need to be presented.

  8. Do I still need to complete a renewal application if my circumstances have not changed?

    Yes, every Medicaid and CHIP beneficiary must complete a coverage renewal application each year, even if no changes have occurred to his or her circumstances. Medicaid programs are required to verify household incomes for every recipient on a yearly basis. Medicaid benefits are subject to change at the state’s discretion, so a petitioner’s eligibility for Medicaid benefits may change regardless of whether or not his or her circumstances have.

  9. What should I do if my household or financial circumstances change?

    Medicaid or CHIP recipients must report any changes in their household or economic circumstances to their state’s Medicaid agency. Coverage eligibility is then determined according to the information provided on the changes. If individuals who are reporting changes to their household no longer qualify for Medicaid, their case is transferred to the Marketplace, where an application for Marketplace health insurance coverage can be submitted.

  10. Are teenagers eligible for Medicaid coverage?

    Teenagers 18 years of age or younger are eligible for Medicaid or CHIP coverage if they are part of a low-income household. Teenagers who are still minors are subject to Medicaid eligibility requirements for children. Most states allow teenagers who live on their own to apply for Medicaid on their own, without an adult. Some states also grant child Medicaid coverage to young adults up to the age of 21.

  11. Who can apply for Medicaid and CHIP on behalf of a child?

    Children and adolescents who are dependents must have their Medicaid or CHIP application filled out by a qualifying adult. The application must be completed on behalf of the child by a parent, grandparent, legal guardian or authorized Marketplace Navigator. Legally emancipated minors may be allowed by their state to file their own application or have any adult submit one on their behalf.

  12. Am I still eligible for Medicaid if I do not cooperate with Child Support Enforcement?

    Parents who are enrolled in Medicaid and do not comply with Child Support Enforcement’s efforts to collect child support may have their benefits reduced or cancelled. Those looking to enroll in a Medicaid program but who are not in good standing with Child Support Enforcement are likely to have coverage denied. A parent’s denial of Medicaid coverage due to unpaid child support payments does not affect a child’s eligibility for Medicaid or CHIP.