Your Free Guide to Medicaid

What Is Medicaid?

Medicaid is a financial assistance program designed to provide affordable coverage to low-income children, pregnant women, families, the elderly and the disabled in the United States, including U.S. territories and tribes.

President Lyndon B. Johnson established the Medicaid program in 1965 as part of an effort to increase access to health insurance in the United States. Today, Medicaid is the primary source of health care for low-income Americans. It is run jointly by the federal, state and local governments.

The federal government requires some benefits and eligibility requirements be included in all state Medicaid programs. However, specific requirements and benefits can vary from state to state.

Refer to the sections called “Medicaid Benefits” and “Medicaid Eligibility by State and Territory” for more information.

Differences Between Medicaid and Medicare

Medicaid and Medicare are both health care programs. However, they have different purposes.

While Medicaid is primarily designed to provide affordable health care for low-income Americans and is operated jointly by the state and federal governments, Medicare is a health care program designed primarily for elderly Americans who are 65 years of age or older.

Medicare is a federal program, which means eligibility requirements and benefits stay the same regardless of location. Medicare requirements are based on work history, spousal eligibility, age, and certain health conditions — not income.

Because Medicaid eligibility includes low-income elderly individuals, some individuals receive both Medicare and Medicaid benefits. Refer to the section called “Dual Eligibility in Medicare and Medicaid” to learn more.

Medicaid Contact Information by State and Territory

State	Medicaid Program	Department Running Program	Main Phone Number	Office Locator
Alabama	Alabama Medicaid	Department of Public Health	1 (334) 242-5000	https://medicaid.alabama.gov/content/10.0_Contact/10.1_Medicaid_Contacts/10.1.1_Medicaid_Locations.aspx
Alaska	Alaska Medicaid	Department of Health and Social Services	1 (800) 478-7778	https://dhss.alaska.gov/dpa/Pages/contacts.aspx
American Samoa	American Samoa Medicaid	State Medicaid Agency	1 (684) 699-4777	https://medicaid.as.gov/
Arizona	Arizona Health Care Cost Containment System	Department of Economic Security	1 (855) 432-7587	https://www.healthearizonaplus.gov/App/Enrollment_Entity_Search_results.aspx?link=Assistor
Arkansas	Arkansas Medicaid	Department of Human Services	1 (800) 285-1131	https://humanservices.arkansas.gov/contact-us/county-office-map/
California	Medi-Cal	Department of Health Care Services Division	1 (800) 541-5555	https://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx
Colorado	Health First Colorado	Department of Human Services	1 (800) 221-3943	https://www.colorado.gov/cdhs/contact-your-county
Commonwealth of the Northern Mariana Islands	CNMI Medicaid	State Medicaid Agency	(670) 664-4890	https://medicaid.cnmi.mp/
Connecticut	Husky Health	Department of Social Services	1 (800) 859-9889	https://portal.ct.gov/dss/About-the-Department-of-Social-Services/Contact
Delaware	Delaware Medicaid	Division of Medicaid and Medical Assistance	1 (866) 843-7212	https://dhss.delaware.gov/dhss/dmma/locations.html
District of Columbia	DC Medicaid	Department of Health Care Finance	(202) 727-5355	https://dhcf.dc.gov/service/medicaid
Florida	Florida Medicaid	Statewide Medicaid Managed Care	1 (877) 711-3662	https://www.flmedicaidmanagedcare.com/
Georgia	Georgia Medicaid	Division of Family and Children Services	(404) 657-5468	https://dfcs.georgia.gov/locations
Guam	Guam Medicaid	Public Health Social Services	(671) 735-7519	https://dphss.guam.gov/location-2/
Hawaii	Med-Quest	Department of Human Services	Oahu: (808) 524- 3370 Elsewhere: 1 (800) 316-8005	https://medquest.hawaii.gov/en/contact-us.html
Idaho	Idaho Medicaid	Department of Health and Welfare	1 (877) 456-1233	https://healthandwelfare.idaho.gov/offices
Illinois	Illinois Medicaid	Department of Healthcare and Family Services	1 (833) 234-6343	https://www.dhs.state.il.us/page.aspx?module=12&officetype=&county=
Indiana	Indiana Medicaid	Office of Medicaid and Policy Planning	1 (800) 457-4584	https://secure.in.gov/apps/fssa/providersearch/map
Iowa	Iowa Medicaid	Department of Human Services	1 (800) 972-2017	https://hhs.iowa.gov/about/hhs-office-locations
Kansas	KanCare	Department for Children and Families	1 (855) 643-8180	https://www.dcf.ks.gov/services/Pages/DCFOfficeLocatorMap.aspx

Kentucky	Kentucky Medicaid	Department for Medicaid Services	1 (800) 635-2570	https://prd.webapps.chfs.ky.gov/Office_Phone/
Louisiana	Healthy Louisiana	Department of Health	1 (855) 229-6848	https://ldh.la.gov/index.cfm/directory/category/158
Maine	MaineCare	Department of Health and Human Services	1 (800) 977-6740	https://www.maine.gov/dhhs/about/contact/offices
Maryland	Maryland Medicaid	Department of Health and Mental Hygiene	1 (877) 463-3464	https://health.maryland.gov/docs/Contact%20Us%20Information.pdf
Massachusetts	MassHealth	Department of Health and Human Services	(800) 841-2900	https://www.mass.gov/service-details/masshealth-enrollment-centers-mecs
Michigan	Michigan Medicaid	Department of Health and Human Services	1 (800) 642-3195	https ://www.michigan.gov/mdhhs/0,5885,7-339-73970_5461—,00.html
Minnesota	MinnesotaCare	Department of Human Services	(651) 431-2670	https://mn.gov/dhs/people-we-serve/adults/health-care/health-care-programs/contact-us/county-tribal-offices.jsp
Mississippi	Mississippi Medicaid	Division of Medicaid	(800) 421-2408	https://medicaid.ms.gov/about/office-locations/
Missouri	MO HealthNet	Department of Social Services	1 (800) 392-1261	https://dss.mo.gov/offices.htm
Montana	Montana Medicaid	Department of Public Health and Human Services	1 (800) 362-8312	https://dphhs.mt.gov/hcsd/officeofpublicassistance
Nebraska	Nebraska Medicaid	Department of Health and Human Services	1 (855) 632-7633	https://dhhs.ne.gov/Pages/Public-Assistance-Offices.aspx
Nevada	Nevada Medicaid	Department of Health and Human Services	1 (877) 638-3472	Northern Office Locations: https://dwss.nv.gov/Contact/Welfare_District_Offices-North Southern Office Locations: https://dwss.nv.gov/Contact/Welfare_District_Offices-South/
New Hampshire	New Hampshire Medicaid	Department of Health and Human Services	1 (844) 275-3447	https://www.dhhs.nh.gov/about-dhhs/locations-facilities
New Jersey	New Jersey Medicaid	New Jersey Medicaid	1 (800) 701-0710	https://www.nj.gov/humanservices/njsna p /home/cbss.shtml
New Mexico	Centennial Care	Human Services Department	1 (800) 283-4465	https://www.hsd.state.nm.us/lookingforassistance/field_offices_1/
New York	New York Medicaid	Department of Health	1 (800) 541-2831	https://www.health.ny.gov/health_care/medicaid/ldss.htm
North Carolina	North Carolina Medicaid	Division of Health Benefits	(888) 245-0179	https://www.ncdhhs.gov/divisions/social-services/local-dss-directory
North Dakota	North Dakota Medicaid	Department of Human Services	(701) 328-7068	https://www.hhs.nd.gov/human-service/zones
Ohio	Ohio Medicaid	Department of Medicaid	1 (800) 324-8680	https://jfs.ohio.gov/about/local-agencies-directory/local-agencies-directory
Oklahoma	SoonerCare	Human Services	(888) 365-3742	https://oklahoma.gov/okdhs/contact-us/dhsofficelocations.html
Oregon	Oregon Health Plan	Health Authority	(800) 273-0557	https://www.okdhs.org/countyoffices/Pages/default.aspx
Pennsylvania	Medical Assistance	Department of Human Services	1 (866) 550-4355	https://www.dhs.pa.gov/Services/Assistance/Pages/CAO-Contact.aspx
Puerto Rico	Puerto Rico Medicaid	Department of Health and Human Services	(787) 765-2929 Ext. 6700	https://medicaid.pr.gov/Home/DescripcionPrograma/
Rhode Island	RI Medicaid	Executive Office of Health and Human Services	(401) 784-8100	https://dhs.ri.gov/about-us/dhs-offices
South Carolina	Healthy Connections Medicaid	Department of Health and Human Services	(888) 549-0820	https://www.scdhhs.gov/site-page/where-go-help
South Dakota	South Dakota Medicaid	Department of Social Services	1 (800) 597-1603	https://dss.sd.gov/findyourlocaloffice/
Tennessee	TennCare	Department of Human Services	1 (800) 342-3145	https://www.tn.gov/humanservices/for-families/supplemental-nutrition-assistance-program-snap/office-locator-family-assistance.html
Texas	Texas Medicaid	Department of Health and Human Services	1 (800) 335-8957	https://www.dshs.texas.gov/regions/default.shtm
U.S. Virgin Islands	Virgin Islands Medicaid	Department of Human Services	(340) 715-6929	https://www.vimmis.com/Lists/Contact%20Virgin%20Islands%20Medicaid/USVI%20Contact%20Information.aspx
Utah	Utah Medicaid	Department of Health and Human Services	Salt Lake City: (801) 538-6155 Other Locations: 1 (800) 662-9651	https://jobs.utah.gov/jsp/officesearch/#/map
Vermont	Green Mountain Care	Department of Vermont Health Access	1 (800) 250-8427	https://www.healthvermont.gov/local
Virginia	Cover Virginia	Department of Medical Assistance Services	1 (833) 522-5582	https://coverva.dmas.virginia.gov/apply/find-help-in-your-area/
Washington	Apple Health	Health Care Authority	1 (800) 562-3022	https://www.dshs.wa.gov/ALTSA/resources
West Virginia	West Virginia Medicaid	West Virginia Medicaid	1 (800) 318-2596	https://dhhr.wv.gov/pages/field-offices.aspx
Wisconsin	BadgerCare	Department of Health Services	1 (800) 362-3002	https://www.dhs.wisconsin.gov/forwardhealth/imagency/index.htm
Wyoming	Wyoming Medicaid	Wyoming Medicaid	(307) 777-7531	https://health.wyo.gov/contact/

Common Medicaid Terms

doctor pressure cuff senior medicaid terms

Beneficiary

An individual who meets all the required criteria for receiving health coverage through the Medicaid program in his or her state or territory and is officially enrolled in a health care plan.

Benefits

The specific health care services and treatments that a beneficiary receives through his or her Medicaid health care plan. There are some mandatory benefits that all states and territories must provide, as well as optional additional benefits that vary throughout the country.

Centers for Medicare and Medicaid Services (CMS)

The federal agency in the Department of Health and Human Services (DHHS) that oversees the Medicaid, Medicare and State Children’s Health Insurance programs.

Coverage

A beneficiary’s right to reimbursement or payment for health care costs under Medicaid or a contract with a Medicaid-approved health care plan. Medicaid health plans outline health coverage options in member handbooks.

Copayment

A fixed fee that a beneficiary pays to a health care provider (like a doctor, hospital or specialist) in exchange for receiving treatment or services. Copayments are sometimes known as “copays.”

The term for dividing up the total cost of health care between Medicaid and the beneficiary. A copayment is an example of a type of cost share that the beneficiary pays out of pocket.

Coinsurance

The percentage of the total cost of a health care service that the beneficiary is responsible for paying out of pocket after they have paid their deductible. For example, if the total cost of services is $100 and the beneficiary’s coinsurance is 20 percent, he or she would pay $20 and the insurance company would pay the rest.

Deductible

The total amount of money a beneficiary must pay before his or her health insurance begins paying. Typically, after meeting the deductible, the beneficiary is then charged copayments for services.

Disability

A limit in a range of major life activities, including seeing, hearing, walking, thinking and working.

Dual-Eligible

A beneficiary who is eligible for both Medicaid and Medicare, as well as payment for Medicare premiums, deductibles and coinsurance.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services

These are mandatory services provided to all Medicaid-eligible children in each state and territory. EPSDT services include preventive health screenings for physical and mental health ailments, vision tests, hearing tests and dental exams.

Family Planning Services

Services involved in promoting healthy pregnancies while avoiding unintended pregnancies. States are allowed to define the specific family planning services covered through Medicaid.

Federal Poverty Level (FPL)

A measure of income that is determined each year by the Department of Health and Human Services. Federal poverty levels are used to determine eligibility for many government assistance programs, including Medicaid.

Federally Qualified Health Center (FQHC)

A health clinic, office or other location that provides health care services to medically underserved areas and populations. Medicaid beneficiaries can receive primary care and other ambulatory care services at community health centers and migrant health centers.

Fee-for-Service (FFS)

A method of health insurance in which the doctor or hospital is paid for providing health care services. With fee-for-service plans, either the beneficiary pays directly and submits a claim to his or her insurance company, or the provider pays on behalf of the beneficiary and files for reimbursement.

Home Health Services

Health care services or treatments that a beneficiary receives in his or her home.

Inpatient Care

Any health service or treatment that requires the beneficiary to be admitted as a patient into a hospital, skilled nursing facility or other health care setting.

Managed Care Organization (MCO)

A health insurance company that has entered into a contract with a state Medicaid agency to provide a specified package of health care benefits to Medicaid enrollees. Some states allow beneficiaries to choose their own MCO, while others assign MCOs based on a set of criteria.

Medically Necessary

A health care service that is needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meets accepted standards of medicine.

Medically Needy

Individuals who have a high amount of medical expenses and qualify for Medicaid coverage categorically, but have incomes that exceed their state or territory’s limits. Some states and territories allow these individuals to receive coverage through Medicaid.

Modified Adjusted Gross Income (MAGI)

Medicaid agencies use an applicant’s MAGI to determine if he or she qualifies for coverage based on income. MAGI includes adjusted gross income as well as untaxed foreign income, non-taxable Social Security benefits and tax-exempt interest. It does not include Supplemental Security Income (SSI).

Out-of-Pocket Costs

Health care fees and costs that are not covered or reimbursed by a health insurance company. These include copayments, coinsurance and deductibles.

Outpatient Care

A health care service or treatment in a hospital that does not require an overnight stay.

Premium

Monthly health insurance fees that beneficiaries pay to remain enrolled in a health care plan.

Prior Authorization

The requirement for a health insurance company or a government program like Medicaid to deem a service “medically necessary” before it is approved as a covered service.

Program of All-Inclusive Care for the Elderly (PACE)

Some states offer specific Medicaid-covered services to adults age 55 or older who need the level of care provided by a nursing facility. Qualifying beneficiaries receive all Medicaid-covered services through the PACE provider in which they enroll.

Qualified Medicare Beneficiary (QMB)

A Medicare beneficiary whose income or assets are too high to qualify for full Medicaid coverage as a dual eligible, but whose income is at or below 100 percent of the federal poverty level (FPL) and whose countable resources do not exceed $4000. QMBs can have Medicaid pay all of their Medicare cost-sharing requirements, including monthly premiums for Part B coverage, and all required deductibles and coinsurance.

Rural Health Clinic

A health care office or clinic located in a rural area or designated as an essential provider of primary care health services.

Supplemental Security Income (SSI)

A monthly benefit paid to individuals with low incomes and who are disabled, blind or 65 years of age or older.

Specified Low-Income Medicare Beneficiary (SLMB)

A Medicare beneficiary whose income or assets are too high to qualify for full Medicaid coverage as a dual eligible, but whose income is between 100 and 120 percent of the federal poverty level (FPL) and whose countable resources do not exceed $4000. SLMBs can have Medicaid pay their monthly premiums, but they are still responsible for paying their cost-sharing requirements.

Medicaid Benefits

Because it is partially operated by state and local governments, Medicaid benefits vary from state to state. However, there are some mandatory benefits that all states must provide to beneficiaries.

Mandatory Benefits

Mandatory benefits must be included in all state Medicaid packages. There may be copayments and other costs involved in seeking these benefits. However, any existing copayments and costs should generally be low and affordable to beneficiaries. Refer to the section called “Medicaid Cost-Sharing” for more information on copayments and costs.

The mandatory benefits are:

Inpatient hospital visits
Outpatient hospital visits
Nursing facility services
Home health services
Physician services
Rural health clinic services
Early and periodic screening, diagnostic and treatment (EPSDT) services
Federally qualified health center services

Lab and x-ray services
Family planning services
Nurse midwife services
Certified pediatric and family nurse practitioner services
Freestanding birth center services, when licensed or otherwise recognized by the state
Medical transportation services
Tobacco cessation counseling services for pregnant women
Medication assisted treatment (MAT)
Service and item costs for beneficiaries enrolled in qualifying clinical trials

Refer to the section called “Common Medicaid Terms” for more explanation of these benefits.

Optional Additional Benefits

Optional benefits may be included in Medicaid benefits in your state, depending on your state’s policies. Check your state or territory’s benefits to determine whether any of the following benefits are included:

Adult daycare services
Allergy services
Ambulatory services
Anesthesia
Bariatric surgery
Breast and cervical care services
Case management services
Chiropractic services
Clinic services
Community-first choice options
Dental services
Denture coverage
Dialysis
Durable medical equipment
Eyeglasses coverage
Gastrointestinal services
Gender reassignment care
Genitourinary services
Health homes for individuals with chronic conditions
Hearing services
HIV/AIDS services
Home-delivered meals
Hospice care
Immunizations
Inpatient psychiatric services for individuals under 21 years of age
Interpreter services
Long-term care
Maternity care
Mental health care
Neurology services
Nutritional counseling services
Occupational therapy
Optometry services
Oral and maxillofacial surgery

Orthotics
Other approved services
Other diagnostic, screening, preventative and rehabilitative services
Other practitioner services
Out-of-state care
Peer-recovery services
Personal care
Physical therapy
Podiatry services
Postpartum care
Prenatal care
Prescription drug coverage
Private duty nursing services
Prosthetics coverage
Radiology services
Reconstructive surgery
Rehabilitative services
Respiratory care services
School-based services
Self-directed personal assistance services
Services for individuals 65 years of age or older in institutions for mental diseases
Services in intermediate care facilities for individuals with intellectual disabilities
Skin services
Speech, hearing and language disorder services
State plan home and community-based services
Transplant care
Tuberculosis-related services
Urgent care
Vision care

Optional Benefits by State and Territory

patient with doctor and nurse medicaid optional benefits

Note:

The list does not include federal mandatory benefits, which are available in all states.

Alabama

Dental services for individuals under 21 years of age who qualify for full Medicaid coverage
Eye care services
Preventative health and education services
Hearing services for individuals under 21 years of age
Home health services
Hospice services
Psychiatric hospital services for children under 21 and adults over 65
Prenatal and postpartum maternity services
Mental health services
Nursing home care services
Out-of-state services
Prescription drugs
Renal dialysis services
Transplant services
Home and community-based care services
Radiology services
Maternity services including prenatal care
Inpatient and outpatient hospital services when medically necessary

Alaska

Ambulatory surgical center services
Behavioral health services
Inpatient psychiatric hospital services for individuals under 21 and over 65
Residential psychiatric treatment services for individuals under 21 years of age
Breast and cervical cancer checkups
Chiropractic services for children
Community first choice services
Dental services including orthodontia for children under age 21
Dialysis for end-stage renal disease
Family planning services and supplies
Hearing services
Home and community-based waiver services
Home health services
Hospice services
In-patient and outpatient hospital services including surgery when medically necessary
Long-term care services
Durable medical equipment and supplies
Nutrition services for high-risk individuals under 21 years of age & pregnant women
Personal care services
Prescription drugs
Podiatry services
Prenatal and postpartum medical services
Private duty nursing services
School-based services, including hearing, speech-language, physical, occupational and behavioral therapy
Physical therapy services
Occupational therapy services
Speech-language therapy services
Medical transportation

Arizona

Immunizations
Prescription drugs
Specialist care
Podiatry services
Behavioral health services
Dialysis
Vision Services for individuals under 21
Dental Services for individuals under 21
Hearing Services for individuals under 21
Family planning services
Pregnancy care
Chiropractic services

Arkansas

Adult Behavioral Health Services for Community Independence (ABHSCI)
Applied Behavior Analysis for children with autism
Ambulatory surgical center services
Hearing services for individuals under 21
Dental services for individuals under 21
Developmental rehabilitation services for children under 3
Chiropractic services
Durable medical equipment
End-stage renal disease services
Health care independence program for medically frail people ages 19-64
Hospice services
Inpatient psychiatric services for individuals under 21
Intermediate care facility services for individuals with intellectual disabilities
Medical supplies
Nursing facility services
Occupational, physical and speech therapy services for individuals under 21
Orthotic appliances
Outpatient behavioral health services
Personal care services
Podiatrist services
Prescription drug coverage
Private duty nursing services
Prosthetic devices
Rehabilitative services
Respiratory care services for individuals under 21
School-based mental health services for individuals under 21
Targeted case management services
Ventilator equipment
Vision services

California

Abortion and family planning services and supplies
Acupuncture
Ambulance transportation
Emergency room services
Bariatric surgery
Podiatry services
Chiropractic services
Allergy care
Treatment therapies (chemotherapy, radiation therapy, etc.)
Dialysis
Outpatient mental health services (including specialty)
Substance use disorder services
Inpatient specialty mental health services
Prescription drug services
Physical and occupational therapy services
Speech therapy/audiology
Durable medical equipment services
Medical supplies, equipment and appliances
Hearing aids
Dental services
Diabetic services
Gender reassignment surgery
Vision services
Personal care services and other long-term services and supports
Prenatal, delivery and postpartum care including a certified nurse, midwife and birthing centers
Preventive services and vaccines
Behavioral health treatment for individuals under 21
Radiology services
Reconstructive surgery (non-cosmetic)
Kidney transplants for individuals under 21

Colorado

Vision services
Dental services
Hospice services
Private nursing services
Mental and behavioral health services
Inpatient mental health services
Outpatient mental health services
Prescription drug services
Durable medical equipment services
Physical and occupational therapy services
Speech therapy services
Transplant services
Immunizations
Hearing services
Podiatry services
Breast reconstruction surgery for individuals with breast disease diagnosis and related surgery in prior 5 years
Radiation therapy and chemotherapy services
Pregnancy services, including coverage for newborns up to age one
Telemedicine
Ambulance services and other medical transportation
Emergency room visits and urgent care facilities
Substance abuse services
Private duty nursing up to 16 hours a day for adults, unlimited for children under 21
Lab and radiology tests
Allergy services
Surgical sterilization for individuals over 21
Contraceptives

Connecticut

Preventive care
Women’s health care and family planning services
Maternity care
Long-term services and supports
Physical and occupational therapy services
Speech therapy services
Hearing services (audiology and hearing aids)
Physical rehabilitation
Dialysis
Vision services
Durable medical equipment (DME) services
Orthotic and prosthetic devices
Hospice services
Dental services
Behavioral health services
Prescription drug services
Home health care
For Husky A, C and D members
- Non-emergency medical transportation
- Smoking cessation
- EPSDT

Delaware

Drug and alcohol abuse services
Speech therapy services
Hearing services
Immunizations
Physical therapy services
Eye exams but not eyeglasses
Prescription drug services
Assistive technology
Mental health and substance abuse services including residential
Case management and coordination
Hospice services
Dental services but not dentures
Telemedicine
Rural health clinic and federally qualified health center services
Ambulatory services for pregnant women and individuals under 18
Lab and x-ray services
Nursing facility services other than mental health facilities for individuals 21 and older
Family planning services but not fertility-related services
Podiatry
Tobacco cessation counseling
School-based services
Chiropractic services
Home health services and supplies and equipment for home use
Licensed midwife services
Private duty nursing
Prosthetic devices
Behavioral services to treat autism in children under 21
Lactation counseling
Day health and rehabilitation for individuals with mental retardation disabilities
Medical transportation

District of Columbia

Eyecare
Ambulatory surgical center
Dental services and related treatment
Dialysis services
Durable medical equipment
Hospice services
Laboratory services including radiology
Medical supplies
Mental health services
Home and Community-Based Services (HCBS)
Transplants

Florida

Allergy services
Ambulatory surgical centers
Anesthesia
Assistive care
Behavioral analysis and services
Birth Center and midwife services
Cardiovascular services
Chiropractic services
Community behavioral health services
County Health Department (CHD) Services
Dental services, oral and maxillofacial surgery
Dialysis
Durable medical equipment (DME) and supplies
Family planning waiver services
Gastrointestinal services
Genitourinary services
Hearing services
Home health services
Hospice services
Integumentary Services
Hospital: inpatient, outpatient, both medical and behavioral
Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) services
Medical Foster Care (MFC) services
Neurology
Nursing facility
Oral and maxillofacial surgery
Orthopedic services
Pain management
Podiatry
Prescription drugs
Prescribed Pediatric Extended Care (PPEC) services
Reproductive services
Respiratory services
School-based services programs
Specialized therapeutic foster care
Targeted case management – mental health
Therapy (Occupational, physical, respiratory, speech-language)
Transplant services
Medical transportation, emergency and non-emergency
Vision services and visual aid

Georgia

Prescription drugs
Behavioral health services including inpatient psychiatric care for individuals under 21
Preventive dental care for children
Kidney transplants; limited liver transplants
Inpatient hospital services up to 30 days, medical and behavioral
MRIs
Nursing facility swing-bed services
Dental services
Home health nursing, aide and medical supplies and equipment
Outpatient dialysis
One series of birthing and parenting classes per year for pregnant women
Tobacco cessation counseling for pregnant women
Family planning services
Certain emergency dental care procedures for adults
Medical equipment and supplies prescribed by a doctor and used in the home
Exams and immunizations for children
Hospice care
Vision services for children (limited service for adults)
Hearing services for children
Mental health clinic services
Case management
Mental Retardation Waiver Program
Community Care Services Program
Independent Care Waiver Program
Orthotics and prosthetics
Podiatry services
Speech, physical and occupational therapy
Psychological services for individuals under 21
Dialysis and services for end-stage renal disease
Durable medical equipment

Hawaii

Adult daycare
Nursing home and assisted living services
Non-medical transportation for seniors
Respite care
Skilled nursing
Behavioral health services
Home delivered meals and home maintenance for individuals who qualify for long-term services
Community care services
Dental care
Dialysis
Durable medical equipment (DME)
Habilitation services
Hospice services
Intellectual and developmental disease (I/DD) services
Immunizations
Long-Term Services and Supports (LTSS)
Organ and tissue transplant services
Outpatient hospital procedures including surgeries at ambulatory surgery centers and sleep laboratory services
Nutritional counseling
Smoking cessations
Urgent care
Vision and hearing services
Pregnancy-related services
Prescription drugs
Rehabilitation services
Termination of pregnancy services

Idaho

Counseling and mental health services
Mental health counseling and services
Dental services
Durable medical equipment (DME) and medical supplies
Emergency and non-emergency medical transportation
Home health care with a doctor’s prescription
Hospice care
Chiropractic services
Nutrition services
Immunizations
Pregnancy services
Prescription drugs
Prosthetics and orthotics
Smoking cessation
Substance abuse treatment services
Vision services
Weight loss services
X-rays

Illinois

Dental services
Maternity care
Surgery
Prescription drugs
Mental health treatment
Substance abuse treatment
Medical supplies and equipment
Nursing home care
Physical, speech and occupational therapy
Eyeglasses and optometrist services
Hearing services
Podiatry services
Chiropractic services
Intermediate care for people who are developmentally disabled
Dialysis services
Hospice care
Respiratory equipment and other medical supplies

Indiana

Prescription and over-the-counter drugs
Mental health care
Substance abuse services
Medical supplies and equipment
Dental care
Vision care
Physical, occupational and speech therapy
Hospice care
Podiatry
Chiropractic care
Lab and x-ray services
Home health care
Nursing facility services
Emergency and non-emergency transportation

Iowa

Ambulance and non-emergency medical transportation
Ambulatory surgical centers
Birth control and family planning
Chiropractic services
Eye exams and eyeglasses
Habilitation services
Home health care
Hospice care
Hospital and urgent care
Prescription drugs and over the counter drugs
Podiatry and orthopedic shoes
Occupational, physical and speech therapy
Tobbaco cessation services
Women’s health services including maternity care and birth centers
Substance abuse services
Mental health care
Dental care
Preventive health services

Kansas

Vaccines
Behavioral health services
Prescription drugs
Eye care visits
Dental care for children (some preventive procedures for adults)
Transportation to medical appointments
Nursing facility services
Heart and lung transplants for adults
Weight loss surgery

Enrollees will have additional benefits based on the health plan they choose: https://www.kancare.ks.gov/consumers/choosing-a-plan

Kentucky

Intermediate care facilities for people with intellectual disabilities
Behavioral health and substance abuse services
Prenatal care
Breast and cervical cancer treatment
Tobacco cessation
Medical transportation
Dental services
Vision services
Prescription drugs

Specific information about covered services can be found by contacting one of the managed care organizations (MCOs) that provide Medicaid in Kentucky. Contact information can be found below:

Aetna Better Health of KY – (855) 300-5528
Anthem Blue Cross Blue Shield – (855) 690-7784
Humana Health Plan – (800) 444-9137
Passport Health Plan – (800) 578-0603
Wellcare of Kentucky – (877) 389-9457

Louisiana

Behavioral health services including psychiatric hospital care
Chemotherapy
Chiropractic care
Dental and orthodontic care
Dentures for adults
Durable medical equipment (DME)
Audiology and hearing aids
Hemodialysis services
Hearing services and hearing aids
Hospice care
Immunizations
Long-term personal care services
Occupational, physical and speech therapy
Pediatric Day Health Care (PDHC)
Program for All-Inclusive Care for the Elderly (PACE)
Prescription drugs
Podiatry services
Prenatal care and midwife services
Psychiatric care and behavioral health for adults
Rehabilitation services
STD clinics
Vision care

Maine

Some of Maine’s covered services require prior authorization. Your doctor will get approval from the MaineCare program.

Preventive services (immunizations, pap smears, mammograms, prostate exams, eye exams)
Behavioral and mental health services
Chiropractic services
Substance use disorder treatment
Durable medical equipment (DME) and supplies including oxygen and oxygen equipment services
Prescriptions
Hearing aids and hearing services
Eye care and vision services
Podiatry
Rehabilitative services
Dental services
Psychiatric inpatient treatment
Dialysis
Hospice services
Intermediate care facility for people with intellectual disabilities
Occupational, physical and speech therapy

Covered services depend on the member’s specific benefit package. For more benefits information, call MaineCare Member Services at 1 (800) 977-6740 or 711 (TTY).

Maryland

Ambulatory surgical services
Ambulatory and wheelchair van services
Biomarker testing (cancer)
Dental services for all ages and dentures for beneficiaries under 21 years of age
Diabetes care
Eyeglasses for beneficiaries under 21 years of age
Family planning services and supplies
Hearing aids for beneficiaries under 21 years of age
Home health care
Hospice care
Dialysis services
Medical daycare services
Medical equipment and supplies
Nursing facilities
Medical transportation
Mental health services
Oxygen and other respiratory services
Personal care services
Pregnancy care
Prescription drugs
Physical therapy
Podiatry services
School-based medical care for children
Statewide Evaluation and Planning Services (STEPS) through local health departments
Substance abuse treatment services
Targeted case management for HIV-infected beneficiaries and other populations
Vision care every two years

Massachusetts

Therapies
Dental services
Prescription drugs including birth control drugs
Vision care and eyeglasses
Hearing aids
Medical equipment and supplies
Adult day health and foster care
Mental health and addiction services
Long-term care services and support at home or in a facility
Smoking cessation services
Medical transportation (requires pre-authorization)
Occupational, physical and speech therapy
Gender affirming care including surgery

Michigan

Chiropractic care
Dental care
Family planning
Hearing and speech services
Home health care
Hospice care
Medical supplies
Prescription drugs
Mental health services
Nursing home care
Private duty nursing
Personal care services
Physical and occupational therapy
Podiatry
Pregnancy and postpartum care
Immunizations
Substance abuse treatment
Surgery
Vision care

Minnesota

Alcohol and drug treatment
Birth center services
Chiropractic care
Dental care
Eyeglasses
Family planning services
Hearing aids
Hospice care
Immunizations
Interpreter services
Medical equipment and supplies
Medical transportation
Mental health care
Intermediate care facilities for people with developmental disabilities
Prescriptions and medication therapy management
Rehabilitative therapy
Urgent care

Mississippi

Ambulatory surgical center
Assisted living facility
Autism spectrum disorder services
Chiropractic care
Community homes and immediate care facilities for people with intellectual disabilities
Dental care, oral surgery and orthodontics
Dialysis services
Durable medical equipment (DME) and medical supplies
Vision and eyeglasses
Hearing aids and services
Hospice services
Long-term care
Medical supplies
Occupational, physical and speech therapy
Organ transplants
Podiatry services
Prescription drugs
Psychiatric care and mental health services including inpatient psychiatric hospitalization
School-based services
Vaccines

Missouri

Ambulatory surgical centers and birthing centers
Audiology services and hearing aids
Asthma services for individuals under 21
Behavioral health and substance use services including emergency
Complementary health and alternative therapy for chronic pain (adults 21 and over)
Case management for pregnant women
Community psychiatric rehabilitation services
Comprehensive substance treatment and rehabilitation (C-STAR)
Dental services
Diabetes prevention program
Comprehensive data rehab for serious head injury
Durable medical equipment (DME) and some prosthetic/orthotic devices
Family planning services
Hearing aids and related services
Hospice care
Non-emergency medical transportation
Personal care and adult day health care services
Podiatry services
Prescription drugs
Private duty nursing for childer under 21
Speech, occupational and physical therapy for children under 21
Orthodontics for children under 21
Rehabilitative services
Transplant services
Vision services and eyeglasses

Montana

Dental care
Audiology and hearing aids
Family planning services
Maternity and newborn care
Mental health and substance abuse services
Prescription drugs
Rehabilitative services and supplies
School-based health services
Speech therapy
Medical transportation
Substance abuse services
Vision services every two years

Nebraska

Chiropractic services
Dental care
Durable medical equipment (DME), orthotics, prosthetics and medical supplies
Family planning services
Hearing aids
Hospice care
Home health agency services
Intermediate Care Facilities for Persons with Intellectual Disabilities (ICF/DD)
Medical transportation services
Mental health and substance abuse services
Nurse midwife services
Nursing facility
Private duty nursing services
Occupational, speech, physical and audiological therapy
Personal assistance services
Podiatry
Prescription drugs
Private-duty nursing
Program of All-Inclusive Care for the Elderly (PACE)
Mammograms
Medically necessary psychiatric and substance abuse services for adults
Vision care every two years

Nevada

Ambulance/transportation
Birth control/family planning
Dental care
Disposable medical supplies
Durable medical equipment (DME)
Eye exams and glasses
Hearing tests
Home health care
Hospice care
Immunizations
Maternity care
Mental health services
Midwife services
Nursing home services
Occupational and physical therapy
Orthotics and prosthetics
Over-the-counter drugs with a prescription
Personal care services
Private duty nursing
Prescription drugs
Smoking cessation products
Specialist visits
Speech and hearing services
Substance abuse services

New Hampshire

Adult medical daycare
Dental care
Durable medical equipment (DME) and medical supplies
Extended services for pregnant women
Hearing services
Hospice services
Interpreter services
Newborn home visits
Nursing facility
Home health
Medical transportation
Interpreter
Certified midwife
Family planning
Personal care attendant services
Physical, occupational and speech therapy
Podiatry
Prescription drugs
Private duty nursing
Psychotherapy
Vision care

New Jersey

Chiropractic services
Dental care
Durable medical equipment (DME)
Family services and supplies
Hearing aid services
Hospice care
Inpatient psychiatric care for individuals under 21 and over 65
Intermediate care facilities for people with intellectual disabilities
Licensed practitioner services
Optical appliances
Personal care services
Physical, occupational and speech therapy
Podiatry
Prescription drugs
Private duty nursing
Prosthetics and orthotics
Psychological care including inpatient psychiatric care for individuals u. der 21 and over65
Intermediate care facilities for the mentally retarded
Vision care

New Mexico

Adult daycare
Preventive services
Behavioral health care
Long-term care
Medical transportation
Vision services
Specialist services

Specific benefits may vary depending on the plan beneficiaries choose. Applicants are able to choose among four Medicaid plans: BlueCross BlueShield, Presbyterian, Western Sky or United Healthcare.

New York

Dental care
Medical supplies and equipment
Mental health services

Home health care including personal care aides
Adult daycare
Physical, occupational and speech therapy
Durable medical equipment
Family planning services
Medicaid Health Homes comprehensive care management
Nursing home services
Preventive services
Personal care services
Prenatal care
Prescription drugs
Smoking cessation agent
Vision care and eyeglasses

North Carolina

Ambulatory surgical centers
Dental and orthodontic services for children
Hearing services
Medical equipment
Mental and behavioral health care

Intellectual/developmental care
HIV case management
Family planning services
Infant toddler program for children up to age 3 with developmental delays
Home health services
Hospice
Nursing facilities
Private duty nursing
Chiropractic services
Durable medical equipment
Dialysis
Well-woman services (OB/Gyn)
Physical, occupational, speech, respiratory and audiology therapy
Radiology
Orthotics and prosthetics
Prescription drugs
Podiatry
Personal care services
Specialized therapy
Vision services and aids

North Dakota

Chiropractic care
Dental care
Durable medical equipment (DME) and supplies
Hospice care
Mental health care
Nursing facility
Home health care
Family planning
Prescription drugs
Podiatry
Speech, physical and occupational therapy
Sterilization
Vision care
Medical transportation

Ohio

Alcohol and drug addiction services
Ambulatory surgical centers
Audiology services
Chiropractic services
Dental care
Medical equipment
Medical transportation emergency and non-emergency
Mental health care
Physical, speech and occupational therapy
Podiatry
Pregnancy care
Prescription drugs
Preventive health services
Private duty nursing
Vision care including surgical

Oklahoma

Ambulatory surgical centers
Behavioral health care including inpatient care for individuals 65 and older
Outpatient substance abuse services
Case management services
Chemotherapy and radiation therapy
Dental care
Dentures for adults residing in nursing facilities
Dialysis
Durable medical equipment (DME) and supplies
Family planning services and supplies
Hemophilia care
Home health services
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
Maternity care
Mental health and substance abuse services
Nutritional Services
Maternity and pregnancy services
Personal care services
Podiatry services
Prescription drugs and insulin
Tuberculosis services
Tobacco cessation services
Transplants with pre-authorization
Ultrasound benefits

Additional services for children include the following:

Hearing aids
Immunizations
Incontinence supplies for certain children
Optometric or optical services, including eyeglasses
Orthodontics
Physical and occupational therapy
Private duty nursing
Speech, hearing and language disorder services
Other medically necessary services

Oregon

Chemical dependency care
Dental care and dentures
Hearing aids and exams
Home health care
Hospice care
Immunizations and vaccinations
Labor, delivery and postpartum maternity care
Medical equipment and supplies
Medical transportation
Mental health care services
Physical, occupational and speech therapy
Prescription drugs
Private duty nursing
Vision care services for pregnant women and children under 21, eyeglasses for pregnant women and adults with a qualifying medical condition

Pennsylvania

Behavioral health services
Chiropractic services
Dental and orthodontic care
Dialysis
Durable medical equipment (DME)
Medical Supplies
Hospice care
Maternity care
Mental health and substance abuse services
Podiatry services
Prescription drugs
Prosthetics and orthotics
Specialist care
Substance abuse services
Tobacco cessation services
Vision care

Rhode Island

Dental care
Durable medical equipment (DME)
HIV/AIDS services
Home stabilization services
Home health care
Assisted living facilities
Nursing homes
Hospice care
Interpreter services
Long-term care
Peer recovery support services
Podiatry
Prescription drugs
Rehabilitative services
Vision care

South Carolina

Alcohol and drug abuse services
Adult daycare services
Ambulatory surgical center
Audiology services
Behavioral health services
Chiropractic services
Durable medical equipment
Eyeglasses and vision care

Autism spectrum disorder services
Dental services
Family planning
Home- and community-based long-term care services
Nursing facilities
Hospice care
Incontinence supplies
Nutritional supplement services
Occupational, physical and speech therapy
Prescription drugs
Private duty nursing
Psychiatric care and behavioral health services
Rehabilitative therapy services
School-based rehabilitative therapy

South Dakota

Chiropractic care
Dental care
Diabetes education
Dietician and nutritionist services
Durable medical equipment (DME) and medical supplies
Chiropractic care
Dental care
Diabetes education
Dietician and nutritionist services
Durable medical equipment (DME) and medical supplies
Family planning and testing for STDs
Hospice care
Home healthcare
Immunizations
Medical transportation
Mental health care
Nursing home services
Personal care services
Physical, speech, occupational and audiology therapy
Podiatry
Pregnancy coverage
Psychiatry / psychology
Prescription drugs
Same-day surgery centers
School district services
Substance abuse services
Urgent care facilities
Vision care and eyeglasses

Tennessee

Behavioral health services
Chiropractic services
Dental services
Dialysis
Durable medical equipment (DME) and medical supplies
Hospice care
Mental health services
Occupational, physical and speech therapy
Organ transplants
Prescription drugs
Private duty nursing
Psychiatric inpatient, residential and rehabilitative services
Reconstructive breast surgery
Substance abuse services
Vision care and one pair of glasses or contacts following cataract surgery

Texas

STAR – Medicaid for children aged 18 or younger, pregnant women and families

Breast and cervical cancer services
Behavioral health services
Hearing services
Mental health care services
Prescription drugs and vaccines
Specialist services
Vision care

Families are not covered unless they are caring for a child 17 or younger who is receiving Medicaid and who meet the income requirements.

STAR Plus – Medicaid for individuals with disabilities or older than 65 years of age

Adaptive aids
Adult foster care services
Assisted living
Home meal delivery and home health care
Intermediate care facilities for individuals with an intellectual disability
Long-term care including nursing facilities
Medical supplies
Minor home safety modifications
Occupational, physical and speech therapy
Personal care services
Respite care
Transitional assistance services

Utah

Birth control
Case management
Chiropractic care
Dental care
Home health care
Hospice care
Individual and group therapy
Maternity and midwife services
Medical supplies
Mental health medication management
Mental health evaluations
Mental health services
Personal care services
Physical and occupational therapy
Podiatry
Prescription and over-the-counter drugs
Psycho-educational services
Psychosocial rehabilitative services
Psychological testing
Respite care
Specialist care
Speech and hearing assistance
Substance abuse services
Tobacco cessation services
Vision care

Vermont

Chiropractic care
Community mental health centers
Dental care
Diabetic supplies
Eye exams but not eyeglasses
Gynecological services
Hearing aids
home health aide and nursing
Hospice care
Immunizations
Medical equipment and supplies
Maxillofacial surgery
Mental health counseling
Midwife services
Naturopaths
Nutrition therapy
Occupational, physical and speech/language therapy
Ophthalmologist
Organ transplants
Podiatry
Prescription and over-the-counter drugs
Prosthetics
Psychiatric and psychological care including psychiatric hospital care
Respiratory therapy
Specialist services
Substance abuse treatment
Medical transportation

Virginia

Addiction and Recovery Treatment Services (ARTS)
Behavioral health services
Dental care, is comprehensive for individu als under age 21 and limited to medically necessary for adults
Dialysis for end-stage renal disease
Durable medical equipment (DME) and supplies
Eye examinations
Eyeglasses for members younger than 21 years of age
Family planning services and birth control
Glucose test strips
Home health visits
Long-term services and support
Nursing facilities
Organ transplants
Personal care
Physical, occupational and speech therapy
Podiatry
Program of All-Inclusive Care for the Elderly (PACE)
Prenatal and maternity services
Prescription drugs
Prosthetic devices
Psychiatric or psychological care including inpatient psychiatric hospital services for individuals under age 21 or age 65 and older; inpatient psychiatric services for patients age 22-64 in the psychiatric wing of an acute care hospital
School health services
Substance abuse treatment

Washington

Alcohol and addiction services
Autism and applied behavioral analysis therapy
Breast, cervical and colon health program
Dental care
Family planning
Gender-affirming treatments and surgery
Home health care
Interpreter services
Long-term services and supports
Medically intensive children’s program (MICP)
Maternity and newborn care
Mental health services
Non-emergency medical transportation
Prescription drugs
Vision screening for children

West Virginia

Cardiac rehabilitation
Chiropractic care
Dental care: comprehensive for individuals age 21 and younger, limited for adults
Diabetes education
Durable medical equipment (DME)
Family planning services and supplies
Home health care
Hospice care
Maternity care
Non-emergency transportation
Nursing home
Nutritional counseling
Orthotics and prosthetics
Personal care services
Physical, occupational and speech therapy
Podiatry
Prescription drugs
Psychiatric care
Pulmonary rehabilitation
Specialty care
Tobacco cessation
X-rays

Wisconsin

Ambulatory surgery centers
Case management services
Chiropractic services
Dental services
Dialysis
Durable medical equipment and disposable supplies
Eyecare, eyeglasses and exams
Family planning services
Hearing services
Home health care
Hospice care
Intermediate care facility (ICF) services
Medical supplies and equipment
Medical transportation
Mental health care and substance abuse services
Nursing home services
Psychosocial rehabilitative services
Personal care services
Physical and occupational therapy
Podiatry services
Prenatal care coordination for women with high-risk pregnancies
Prescription and over-the-counter drugs
Respiratory care services for ventilator-dependent members
Speech, hearing, and language disorder services
Substance abuse services
Tuberculosis (TB) services
Vision care services including eyeglasses

Wyoming

Ambulatory surgical center services
Care management entity as an alternative to a psychiatric residential treatment facility for individuals age 21 and younger
Chiropractic services
Dental services for individuals age 21 and younger, limited orthodontics for children ages 6-18; for adults over age 21, preventative and emergency dental services
Developmental center services for children age 5 and younger
Developmental disability comprehensive services
Dietician services
Durable medical equipment
Dialysis
Family planning services
Hearing services including hearing aids
Home health services
Intermediate care facility for the intellectually disabled
Interpretation services
Mental health and substance abuse services
Nurse midwife services
Nursing facility services
Organ transplant services
Prosthetics and orthotics
Psychiatric hospital services for individuals over the age of 21
Speech, occupational and physical therapy
Medical transportation
Vision services including eyeglasses for individuals under the age of 21

U.S. Territories:

American Samoa

American Samoa is exempt from covering mandatory benefits. It provides 10 of the 17 mandatory benefits. Examples of mandatory programs it does not offer include:

Nursing facility services
Nurse midwife services
Freestanding birth center services

Optional benefits offered by American Samoa Medicaid include:

Dental care
Psychologist Services
Prescription drugs
Federally qualified health center (FQHC) benefits
Early and periodic screening, diagnostic and treatment (EPSDT) services for any members younger than 21 years of age
Chiropractic services
Dental services including dentures
Eyeglasses
Home health services
Hospice services
Inpatient hospital and nursing facility services for individuals age 65 or older in institutions for mental diseases
Intermediate care facility services for individuals with intellectual disabilities
Occupational, physical and speech therapy
Optometry services
Personal care services
Primary care case management services
Private duty nursing services
Prosthetic devices
Respiratory care for ventilator-dependent individuals
Services furnished in a religious nonmedical health care institution

Guam

Guam provides all mandatory benefits. Optional benefits in Guam include:

Dental care
Prescription drug coverage
Chiropractic services
Dental services including dentures
Eyeglasses
Home health services
Hospice services
Inpatient hospital and nursing facility services for individuals age 65 or older in institutions for mental diseases
Intermediate care facility services for individuals with intellectual disabilities
Occupational, physical and speech therapy
Optometry services
Personal care services
Primary care case management services
Private duty nursing services
Prosthetic devices
Respiratory care for ventilator-dependent individuals
Services furnished in a religious nonmedical health care institution

Commonwealth of Northern Mariana Islands

The Commonwealth of Northern Mariana Islands Medicaid program covers all mandatory benefits except freestanding birth center services. It also offers the following benefits:

Clinic services
Dental care and dentures
Chiropractic services
Dental services including dentures
Eyeglasses
Home health services
Hospice services
Inpatient hospital and nursing facility services for individuals age 65 or older in institutions for mental diseases
Intermediate care facility services for individuals with intellectual disabilities
Occupational, physical and speech therapy
Optometry services
Personal care services
Prescription drugs
Medical supplies
Physical and occupational therapy
Primary care case management services
Prescription drugs
Private duty nursing
Respiratory care for ventilator-dependent individuals
Prosthetics
Rehabilitative Services
Speech, hearing and language disorder services
Services furnished in a religious nonmedical health care institution
Targeted case management services
Tuberculosis-related services

Puerto Rico

Comprehensive information about covered services is not readily available. To learn about all services offered, contact the Department of Health at (787) 765-2929 ext. 6700.

Puerto Rico is exempt from covering mandatory benefits. It provides 10 of the 17 mandatory benefits. Examples of mandatory programs it does not offer include:

Nursing facility services
Non-emergency medical transportation
Emergency medical services for non-citizens

Optional benefits offered by Puerto Rico Medicaid include:

Dental care ~~and~~
Prescription drugs.
Chiropractic services
Dental services including dentures
Eyeglasses and optometry services
Home health services
Hospice services
Inpatient hospital and nursing facility services for individuals age 65 or older in institutions for mental diseases
Intermediate care facility services for individuals with intellectual disabilities
Occupational, physical and speech therapy
Optometry services
Personal care services
Primary care case management services
Private duty nursing services
Prosthetic devices
Respiratory care for ventilator-dependent individuals
Services furnished in a religious nonmedical health care institution

U.S. Virgin Islands

Comprehensive information about covered services is not readily available. To learn about all services offered, contact the Department of Human Services (DHS) at the following phone numbers:

St. Thomas: (340) 774-0930
St. Croix: (340) 718-2980
St. John: (340) 776-6334

The U.S. Virgin Islands does not cover two of the mandatory benefits: rural health clinics and freestanding birth centers. Optional benefits include:

Dental services ~~and~~
Prescription drugs
Chiropractic services
Dental services including dentures
Eyeglasses and optometry services
Home health services
Hospice services
Inpatient hospital and nursing facility services for individuals age 65 or older in institutions for mental diseases
Intermediate care facility services for individuals with intellectual disabilities
Occupational, physical and speech therapy
Optometry services
Personal care services, primary care case management services
Private duty nursing services
Prosthetic devices
Respiratory care for ventilator-dependent individuals
Services furnished in a religious nonmedical health care institution

Services Not Covered by Medicaid

Some services are not covered by Medicaid at all. For these services, individuals must seek alternative sources of funding or pay out of pocket to seek them.

If your state’s Medicaid plan does not have a particular service listed, you should assume it is not included in your benefits. However, in some cases, there may be exceptions to the list depending on an individual’s medical history, proposed treatment plan, doctor and state.

The best way to find out if you can get coverage for a service not included in your state’s standard benefits is to contact your state’s Medicaid office. Refer to the “Medicaid Contact Information By State and Territory” section to learn who you can reach out to about unlisted services.

Medicaid Expansion

Prior to the year 2010, states set different Medicaid eligibility requirements for different groups, and generally excluded low-income adults with no children or disabilities.

In 2010, the Affordable Care Act (ACA) was signed by President Barack Obama. As part of the ACA’s effort to expand health insurance coverage nationwide, states were required to expand Medicaid coverage to include all individuals whose income equaled 138 percent of the Federal Poverty Level or lower.

However, a 2012 Supreme Court ruling determined that states had the option to choose whether or not to expand Medicaid coverage to meet this new requirement. Some states have chosen to expand coverage, and some states have chosen not to expand coverage.

As of 2024, 41 states (including the District of Columbia) have adopted the Medicaid expansion and 10 have not. Your state’s choice to expand or not expand coverage can impact whether or not you qualify for Medicaid.

States That Have Expanded Medicaid Coverage

The following states have adopted expanded Medicaid income eligibility requirements under the Affordable Care Act:

Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Hawaii
Idaho
Illinois
Indiana

Iowa
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey

New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Dakota
Utah
Vermont
Virginia
Washington
West Virginia

States That Have Not Expanded Medicaid Coverage

The following states have not adopted expanded Medicaid eligibility requirements under the Affordable Care Act:

Alabama
Florida
Georgia
Kansas
Mississippi
South Carolina
Tennessee
Texas
Wisconsin
Wyoming

For states that have not expanded the requirement, you must check the state’s individual eligibility requirements to determine if you qualify for Medicaid. Learn more about eligibility requirements by location in the section called “Medicaid Eligibility By State and Territory”.

What to Do if Your Location Has Not Expanded Medicaid

If your state has not expanded Medicaid requirements, you may still have options for obtaining health insurance or financial assistance for medical coverage.

Check the Marketplace

Even if you can not get coverage through Medicaid, you might be eligible for a plan through the Health Insurance Marketplace. This can be costly since you will have to pay higher premiums and more out-of-pocket expenses. However, if you have serious medical needs but do not qualify for Medicaid and cannot get health insurance through work, the Marketplace may be the best option. For information on the marketplace, go to https://www.healthcare.gov/.

If your income is between 100 and 400 percent of the Federal Poverty Level, you can get a premium tax credit that you can put toward a plan from the Marketplace. This tax credit allows you to lower the monthly cost of your premium payments to help make them more affordable. For more information on tax credits, go to https://www.irs.gov/affordable-care-act.

Reapply If Your Circumstances Change

Even if you are not eligible for Medicaid coverage when you initially apply, you may be able to receive coverage if your disability status, income or family status changes. You are allowed to reapply for Medicaid coverage if you believe your current circumstances merit coverage through the program.

Consider Relocating

If your medical expenses are costly and you cannot receive Medicaid in your current state, it may make sense to relocate to a state with expanded Medicaid coverage. If you have the ability to relocate to a state where you can earn the same or similar income and receive Medicaid assistance, you should calculate the potential costs and benefits and determine if moving is the right choice for you.

Medicaid Eligibility by State and Territory

doctor mom and child medicaid eligibility

While states that have elected to expand Medicaid generally have the same eligibility requirements, states that have not done so may have a variety of different prerequisites to qualify. Check the requirements in your state below to see if you are eligible for Medicaid benefits.

Understanding Common Eligibility Requirements

Most states require individuals to earn somewhere below 138 percent of the FPL to qualify for Medicaid.

The 2024 FPL chart for the 48 contiguous states and Washington, D.C. is as follows:

Family Size	Annual Income Limit
1	$15,060
2	$20,440
3	$25,820
4	$31,200
5	$36,580
6	$41,960
7	$47,340
8	$52,720
For families/households with more than 8 persons, add $5,380 for each additional person.

The 2024 FPL chart for Alaska is as follows:

Family Size	Annual Income Limit
1	$18,810
2	$25,540
3	$32,270
4	$39,000
5	$45,730
6	$52,460
7	$59,190
8	$65,920
For families/households with more than 8 persons, add $6,730 for each additional person.

The 2024 FPL chart for Hawaii is as follows:

Family Size	Annual Income Limit
1	$17,310
2	$23,500
3	$29,690
4	$35,880
5	$42,070
6	$48,260
7	$54,450
8	$60,640
For families/households with more than 8 persons, add $6,190 for each additional person.

Income limits generally are based on Modified Adjusted Gross Income (MAGI). MAGI includes adjusted gross income, plus untaxed foreign income, non-taxable Social Security benefits and tax-exempt interest. It does not include Supplemental Security Income (SSI).

Aged, blind, and disabled individuals, as well as SSI recipients, are exempt from MAGI-based income requirements. Instead, they rely on SSI income calculations.

In addition, states have citizenship requirements. To be eligible for Medicaid, applicants should be a U.S. citizen or legal non-citizen, and be able to supply a Social Security Number (SSN) or an application for an SSN.

Asset limits may be required for MAGI-exempt Medicaid applicants. These limits involve measuring your liquid funds, such as bank accounts, CDs and investments. Your primary residence and one car are exempt from asset tests.

Note on Native American and Alaskan Native Eligibility for Medicaid:

Native American tribes and individuals who meet the requirements are eligible through Medicaid and all other programs funded through the Centers for Medicare and Medicaid Services. States may develop outreach programs to more effectively enroll Native Americans into Medicaid programs.

Native Americans eligible for Medicaid do not have to pay premiums, enrollment fees or out-of-pocket costs. Additionally, American Indian and Alaskan Native trust income is not counted when determining eligibility.

Note on Eligibility Group Abbreviations:

QMB refers to low-income Medicare beneficiaries.

SLMB refers to Specified Low-Income Medicare Beneficiaries and refers to individuals with Medicare Part A and limited incomes.

Working Disabled individuals are disabled individuals who work to “buy in” to the Medicaid program when their income is higher than the standard income requirements.

Alabama

To qualify for Alabama Medicaid, the following must be true:

All Medicaid beneficiaries must be Alabama residents.
All Medicaid beneficiaries must be U.S. citizens or qualified U.S. residents.
All Medicaid beneficiaries must meet the income eligibility requirements: https://medicaid.alabama.gov/documents/3.0_Apply/3.2_Qualifying_Medicaid/3.2_Medicaid_Income_Limits_2023_2-16-24.pdf

Eligibility for Children

Children must be 18 years of age or younger.

Eligibility for Parents and Caretakers

Applicants must have a close relative under the age of 19 living with them.
Applicants must assign all medical insurance and support benefits to the state.
Applicants must report all household changes immediately.

Eligibility for Pregnant Women

Pregnant women under 19 years of age may receive full coverage if their parents’ income is counted and meets the income eligibility requirements.

Check to see if you meet Alabama’s income requirements for Medicaid here: https://www.benefits.gov/benefit/1618

Alaska

The Alaska Medicaid Eligibility requirements are as follows:

Medicaid beneficiaries must be Alaska residents.
Medicaid beneficiaries must be U.S. citizens or qualifying U.S. residents.

Check to see if you meet Alaska’s Medicaid eligibility requirements here: https://aries.alaska.gov/screener/accessScreener?id=0.2760063399882704

American Samoa

American Samoa does not have an application process or an eligibility checklist. The territory operates through presumptive eligibility.

American Samoa receives funding based on a calculation of the percentage of the population with income levels below 200 percent of the FPL. Qualifying residents automatically receive Medicaid based on that calculation.

Arizona

The Arizona Medicaid Eligibility requirements are as follows:

Medicaid beneficiaries must be Arizona residents.
Medicaid beneficiaries must be U.S. citizens or qualifying U.S. residents.
Medicaid beneficiaries must have a Social Security Number.

Check to see if you meet the income requirements for Arizona Medicaid here: https://www.azahcccs.gov/Members/Downloads/EligibilityRequirements.pdf

Arkansas

To qualify for Arkansas Medicaid, all of the following must be true:

You are a U.S. citizen, national, legal alien or permanent resident.
You are a current Arkansas resident.
You have a household income below 138 percent of the FPL, or below 200 percent of the FPL if you are a pregnant woman.

Most Arkansas Medicaid recipients meet at least one of the following qualifications:

You are 65 years of age or older.
You are 18 years of age or younger.
You are blind or disabled.
You are pregnant.
You are a parent taking care of a child with an absent, unemployed or disabled parent.
You are living in a nursing home.
You are under 21 years of age and in the foster system.
You medically require certain home and community-based services.
You have breast cancer or cervical cancer.
You are a parent or relative taking care of a child.
You are between 19 and 64 years of age with a low income when participating in the ARHOME program

Check if you meet Arkansas’s Medicaid income requirements here: https://humanservices.arkansas.gov/wp-content/uploads/Quick-Reference-Medicaid-Chart-3.3.23.pdf

California

To qualify for California Medicaid, your household income must fall below 138 percent of the FPL.

You may also qualify for Medicaid in California if any of the following are true:

You are 65 or older.
You are blind or disabled.
You are under 21.
You are pregnant.
You are in a nursing or intermediate care home.
You have refugee status for a limited time.
You are a parent or related caretaker of an age-eligible child.
You have been screened for breast or cervical cancer.
You are enrolled in CalFresh.
You receive Supplemental Security Income or are enrolled in the State Supplemental Program.
You are enrolled in CalWorks.
You are enrolled in RefugeeAssistance.
You are enrolled in the Foster Care or Adoption Assistance Program.

Check if you meet California’s Medicaid income eligibility requirements here: https://www.coveredca.com/see-if-you-qualify-for-financial-help/

Colorado

You may qualify for Medicaid in Colorado if you fall into any of the following groups:

Children ages 0-18 with a household income under 260 percent of the FPL
Pregnant women, over the age of 19, whose household income is under 260 percent of the FPL
Parents and Caretaker Relatives (you must have a dependent child) whose household income does not exceed 133 percent of the FPL
Adults without dependent children whose household income does not exceed 133 percent of the FPL

Check if you meet Colorado’s Medicaid eligibility requirements here: https://coloradopeak.secure.force.com/AC_Welcome?Language=EN

Commonwealth of Northern Mariana Islands

All individuals who receive SSI in the Northern Mariana Islands are eligible for Medicaid.

In addition, all individuals whose incomes and resources fall below 150 percent of the SSI income and resource standards are eligible as well.

Connecticut

You may qualify for Medicaid in Connecticut if you meet the following eligibility requirements (the income limits provided are total annual household income limits):

Check to see if you meet Connecticut Medicaid eligibility requirements here: https://portal.ct.gov/-/media/hh/pdf/husky-health-annual-income-chart-march-1-2024.pdf

Delaware

You may qualify for Medicaid in Delaware if you meet the following eligibility requirements:

You are a Delaware resident.
You are a citizen or legal non-citizen.

You must also meet these other eligibility requirements:

Parents and caretakers must have a household income below 87 percent of the FPL.
Children under 6 years of age must have a household income below 142 percent of the FPL.
Children between 6 and 18 years of age must have a household income below 133 percent of the FPL.
Adults with no children must have a household income below 133 percent of the FPL.
Pregnant women must have a household income below 212 percent of the FPL.

Check to see if you meet Delaware’s Medicaid income eligibility requirements here: https://www.dhss.delaware.gov/dmma/fpl.html

District of Columbia

To qualify for Medicaid in the District of Columbia, you must be a resident of D.C. and a U.S. citizen or legal non-citizen. You must fall into one of the following groups:

Children
Youth
Pregnant women
Aged, blind or disabled individuals
Low-income adults

Check the income requirements for Medicaid in the District of Columbia here: https://dhcf.dc.gov/node/892172

Florida

You must be a Florida resident and a U.S. citizen or legal non-citizen to qualify for Medicaid in Florida. In addition, you must fall into one of the following groups:

Parents and caretakers for children
Children 18 years of age or younger
Pregnant women
Former foster care recipients
Non-citizens with medical emergencies
Older and disabled individuals who do not receive Supplemental Security Income (SSI)

In general, your household income should fall below 133 percent of the FPL to qualify for Medicaid.

Check to see if you are eligible for Medicaid benefits in Florida here: https://dcf-access.dcf.state.fl.us/access/scrflaiewelcome.do?performAction=init&showMensaje=true

Georgia

In Georgia, you may qualify for Medicaid if you are a Georgia resident and a U.S. citizen or legal non-citizen, and fall into any of the following categories:

You think you are pregnant.
You have been diagnosed with breast or cervical cancer.
You are a child or teenager 18 years of age or younger.
You are 65 years of age or older.
You are blind.
You have disabilities.
You need nursing home care.
You are part of a family with children under 19 and have very low or no income.
You are a child who was adopted or in foster care.

Check to see if you meet Georgia Medicaid income eligibility requirements here: https://medicaid.georgia.gov/how-apply/basic-eligibility

Guam

Apply using the Application for Public Benefits.
Download the form here: https://dphss.guam.gov/wp-content/uploads/2019/05/ApplicationforPublicBenefits.pdf
When the form is complete, return it to DPHSS at:
DPHSS
123 Chalan Kareta
Mangilao, Guam 96913-6304

Hawaii

To qualify for Medicaid in Hawaii, you must meet the following requirements:

Be a Hawaii resident.
Be a U.S. citizen or a permanent legal non-citizen.
Be a qualified non-citizen.
Have a household income at or below 133 percent of the FPL, except for pregnant women and children up to age 6.

Check to see if you’re eligible for Medicaid in Hawaii by taking the Pre-Assessment here: https://medical.mybenefits.hawaii.gov/web/kolea/home-page

Idaho

In Idaho, you may be eligible for Medicaid if you meet the following requirements:

You are a resident of Idaho.
You are a U.S. citizen or legal permanent resident.
You meet the income eligibility requirements.

Additionally, you must also meet one of the following requirements:

You are under 19 years of age.
You are a parent or caretaker of someone under 19 years of age.
You are a pregnant woman.
You are a woman diagnosed with breast cancer, cervical cancer or pre-cancer.
You are 65 years of age or older.
You are blind or disabled.

In general, adults can get Medicaid in Idaho if their income falls below 138 percent of the FPL.

Check to see if you meet the Idaho Medicaid income eligibility guidelines here: https://healthandwelfare.idaho.gov/medicaid-program-income-limits

Illinois

In Illinois, you must meet one of the following requirements in order to be eligible for Medicaid:

You are blind or disabled.
You are 65 years of age or older.
You are a low-income adult between 19 and 65 years of age.
You are a pregnant woman.
You have children under the age of 19 years old.
You are an adult between 19 and 26 years old who aged out of the foster system, regardless of income.
You are a woman with breast or cervical cancer.

In addition, all applicants except children must be U.S. citizens or legal permanent residents.

The Illinois income eligibility requirements are:

Adults and parents or caretakers must have a household income below 138 percent of the FPL.
Seniors, disabled and blind individuals should have household incomes below 100 percent of the FPL.
Children should have household incomes below 147 percent of the FPL for full Medicaid.
Children should have household incomes below 318 percent of the FPL for partial Medicaid coverage.
Pregnant women should have household incomes below 213 percent of the FPL.
Women with breast or cervical cancer should have household incomes below 200 percent of the FPL.
Workers with disabilities should have household incomes below 350 percent of the FPL.
Qualified Medicare Beneficiaries should have household incomes below 135 percent of the FPL.

Check to see if you’re eligible for Illinois Medicaid benefits here: https://abe.illinois.gov/abe/access/accessController?id=0.041288096558023124

Indiana

In Indiana, you must meet one of the following requirements in order to qualify for Medicaid:

You are a low-income adult between 19 and 64 years of age.
You are a low-income caretaker or parent with children below 19 years of age.
You are a low-income pregnant woman.
You are a foster child or former foster child up to 26 years of age.
You are 65 years of age or older.
You are blind or disabled.

In addition, you must be a U.S. citizen or permanent legal resident, as well as a current Indiana resident, to qualify for Medicaid in the state.

Check to see if you meet the Indiana Medicaid income eligibility guidelines here: https://www.in.gov/medicaid/members/apply-for-medicaid/eligibility-guide/

Iowa

In order to qualify for Medicaid in Iowa, you need to be an Iowa resident as well as a U.S. citizen. In addition, you must also fall into one of the following categories:

A child under the age of 21
A parent living with a child under the age of 18
A woman who is pregnant
A woman in need of treatment for breast or cervical cancer
A person who is 65 years of age or older
A person who is blind or disabled
An adult between the ages of 19 and 64 and whose income is at or below 133 percent of the FPL

Your household income must generally fall below 133 percent of the FPL.

Check to see if you are eligible for Medicaid in Iowa here: https://hhsservices.iowa.gov/apspssp/ssp.portal

Kansas

In Kansas, you must be a U.S. citizen or permanent legal resident to receive Medicaid coverage. In addition, you must fall into one of the following categories:

Children under 19 years of age
Pregnant women
Adult parents and caregivers
Seniors, blind and disabled individuals

In general, your household income must fall below 133 percent of the FPL.

Check to see if you meet the Kansas Medicaid income eligibility guidelines here: https://www.kancare.ks.gov/docs/default-source/policies-and-reports/kdhe-keesm/appendix/financial/f-8-ks-medical-standard.pdf?sfvrsn=2f81511b_36

Kentucky

To qualify for Medicaid in Kentucky, you must be a Kentucky resident as well as a U.S. citizen or permanent legal resident. In addition, you must be part of a low-income household and belong to one of the following categories:

Blind or disabled individuals
Children under 19 years of age
Adults or caretakers with children under 19 years of age
Individuals under 26 years of age in the foster care program
Pregnant women

In general, your household income must fall below 133 percent of the FPL.

Check to see if you meet the income eligibility guidelines for Medicaid in Kentucky here: https://www.chfs.ky.gov/agencies/dms/dpo/epb/Pages/enroll.aspx

Louisiana

In order to receive Medicaid in Louisiana, you must be a Louisiana resident and a U.S. citizen, permanent resident or legal alien. In addition, you must fall into one of the following categories:

You receive Supplemental Security Income from the Social Security Administration.
You get financial help from the Office of Family Support.
You are disabled or blind.
You are a parent of children under age 19.
You are under 19 years of age.
You are a pregnant woman.
You have no insurance and need treatment for breast and/or cervical cancer.
You receive Medicare coverage and are low-income.
You are an adult between 19 to 64 years of age.

You must meet the income requirements in Louisiana to get coverage. Most applicants must earn less than 138 percent of the FPL to receive coverage. Children need a household income below 255 percent of the FPL to get coverage. Workers with disabilities can get coverage if they earn less than 100 percent of the FPL.

Check to see if you meet the Louisiana Medicaid income eligibility guidelines here: https://ldh.la.gov/page/medicaid-eligibility-income-limits

Maine

In order to receive Medicaid in Maine, you must be a low-income Maine resident and a U.S. national, citizen, permanent resident or legal alien.

Additionally, you must fall into one of the following categories:

Low-income adults between 19 and 64 years of age
Children under 21 years of age
Parent or caretaker of a child under 18 years of age
Pregnant woman
Aged, blind or disabled adult
Adult working with a disability

Check to see if you meet the Maine income eligibility guidelines here: https://www.maine.gov/dhhs/ofi/programs-services/health-care-assistance

Maryland

To qualify for Medicaid in Maryland, you must be a Maryland resident as well as a U.S. citizen or legal resident. In addition, you must belong to one of the following categories:

Low-income adults
Children under 19 years of age
Former foster care youth under 26 years of age
Parents and caretakers of children under 19 years of age
Disabled and blind individuals
Low-income seniors over 65 years of age
Pregnant women
Medically needy individuals
Disabled working adults
Refugees

Check to see if you meet the Maryland income eligibility guidelines here: https://health.maryland.gov/mmcp/Pages/Medicaid%20Eligibility%20Requirements.aspx

Massachusetts

In Massachusetts, you may qualify for Medicaid if you are a Massachusetts resident as well as a U.S. citizen or legal permanent resident. In addition, you must fall into one of the following categories:

Parents or caretakers of children under 19 years of age
Children under 19 years of age
Adults between 20 and 64 years of age
Pregnant women
Disabled and blind adults
Women with breast or cervical cancer
Seniors and individuals who need long-term care

Check to see if you meet the income eligibility guidelines for Medicaid in Massachusetts here: https://www.mass.gov/info-details/program-financial-guidelines-for-certain-masshealth-applicants-and-members#2024-masshealth-income-standards-and-federal-poverty-guidelines-

Michigan

To qualify for Medicaid in Michigan, you must be a U.S. citizen or legal non-resident as well as a resident of the state of Michigan. You must also have an income below 133 percent of the FPL, in general. You must also fall into one of the following groups:

Disabled or blind individuals
Seniors
Low-income families
Low-income adults
Children of low-income families
Pregnant women

Check to see if you are meet the income eligibility guidelines for Medicaid in Michigan here: https://www.michigan.gov/healthymiplan/who

Minnesota

In order to qualify for Medicaid in Minnesota, you must meet the following eligibility requirements:

You must be a U.S. citizen.
You must be a resident of Minnesota.
You must meet the income and asset limits.

Check to see if you meet the Minnesota income eligibility guidelines here: https://edocs.dhs.state.mn.us/lfserver/Public/DHS-3461A-ENG

Mississippi

To be eligible for Medicaid in Mississippi, you must be a U.S. citizen or legal permanent resident, as well as a Mississippi resident. You must also belong to one of the following groups:

Infants and children between 0-18 years of age
Parents and caretakers of minors
Pregnant women
Disabled or blind individuals
Seniors

Check to see if you meet the Mississippi income eligibility guidelines here: https://medicaid.ms.gov/medicaid-coverage/who-qualifies-for-coverage/income-limits-for-medicaid-and-chip-programs/

Missouri

You may be eligible for Medicaid in Missouri if you are a U.S. citizen or qualified resident, a Missouri resident and you belong to one of the following qualifying groups:

Disabled and blind individuals
Seniors
Pregnant women
Children
Uninsured women
Families
Women with breast or cervical cancer

Check to see if you meet the Missouri income eligibility guidelines here: https://mydss.mo.gov/benefit-program-income-limits

Montana

You may be eligible for Medicaid in Montana if you are a state resident as well as a U.S. citizen or legal non-resident.

You must also belong to one of the following groups:

Pregnant women
Parents or caretakers
Aged, blind and disabled individuals

You should also check to see if you meet the income requirements. Generally, individuals should have a household income below 138 percent of the FPL to qualify.

Check to see if you meet the Montana income eligibility guidelines here: https://dphhs.mt.gov/healthcare/apply

Nebraska

You may be eligible for Medicaid in Nebraska if you are a state resident as well as a U.S. citizen or legal non-resident.

You should also belong to one of the following groups:

Aged, blind or disabled individuals
Children
Pregnant women
Parents or caretakers
Former foster care youth

Your resources should not exceed $4,000 for an individual, $6,000 for a couple and $25 for each additional family member. Children and pregnant women are not subject to this limitation.

Check to see if you meet the income eligibility guidelines for Medicaid in Nebraska here: https://dhhs.ne.gov/Documents/FPL%20Eligibility.pdf

Nevada

You may be eligible for Medicaid in Nevada if you are a state resident as well as a U.S. citizen or legal non-resident.

You should also belong to one of the following groups:

Children
Pregnant women
Low-income families
Aged, blind and disabled individuals
Former foster care youth

You must also meet the income requirements. In general, your household income should fall below 138 percent of the FPL to qualify for Medicaid in Nevada. Children can receive Medicaid if their household incomes fall below 205 percent of the FPL; working disabled individuals need to earn less than 250 percent of the FPL.

Check to see if you meet the Nevada income eligibility guidelines here: https://dwss.nv.gov/uploadedFiles/dwssnvgov/content/Home/Features/Peace_of_Mind_brochure.pdf

New Hampshire

You may be eligible for Medicaid in New Hampshire if you are a state resident as well as a U.S. citizen or legal non-resident. You should not be getting medical assistance from other states.

You must also belong to one of the following groups:

Children
Pregnant women
Low-income families
Low-income adults
Aged, blind and disabled individuals
Former foster care youth

Check to see if you meet the New Hampshire income eligibility guidelines here: https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documents2/bfa-progam-fact-sheet.pdf

New Jersey

You may be eligible for Medicaid in New Jersey if you are a state resident as well as a U.S. citizen or legal non-resident. You must also belong to one of the following groups:

Families with dependent children
Aged, blind or disabled individuals
Children
Pregnant women
Disabled individuals

Check to see if you meet the New Jersey income eligibility guidelines here: https://njfamilycare.dhs.state.nj.us/who_eligbl.aspx

New Mexico

You may be eligible for Medicaid in New Mexico if you are a state resident as well as a U.S. citizen or legal non-resident. You must also belong to one of the following groups:

Families with dependent children
Aged, blind and disabled individuals
Children
Pregnant women
Disabled individuals

Check to see if you meet the income eligibility guidelines for Medicaid in New Mexico here: https://www.hsd.state.nm.us/wp-content/uploads/MAD-222-2024-2025.pdf

New York

You may be eligible for Medicaid in New York if you are a state resident as well as a U.S. citizen or legal non-resident. You must also belong to one of the following groups:

Families with dependent children
Aged, blind and disabled individuals
Children
Pregnant women
Disabled individuals.

In general, low-income adults must earn less than 138 percent of the FPL.

Check to see if you meet the New York income eligibility guidelines here: https://www.nyc.gov/assets/ochia/downloads/pdf/all_populations_medicaid.pdf

North Carolina

You may be eligible for Medicaid in North Carolina if you are a state resident as well as a U.S. citizen or legal non-resident. You must also belong to one of the following groups:

Families with dependent children
Aged, blind and disabled individuals
Children
Pregnant women
Disabled individuals

Check to see if you meet the North Carolina income eligibility guidelines here: https://medicaid.ncdhhs.gov/north-carolina-expands-medicaid

North Dakota

You may be eligible for Medicaid in North Dakota if you are a state resident as well as a U.S. citizen or legal non-resident. You must also belong to one of the following groups:

Low-income adults
Children in foster care or subsidized adoption
Former foster care children up to age 26, under certain circumstances
Children with disabilities (birth to 19)
Pregnant women
Individuals with breast or cervical cancer
Workers with disabilities
Other blind and disabled individuals
Low-income Medicare beneficiaries

Check to see if you meet the North Dakota income eligibility guidelines here: https://www.hhs.nd.gov/healthcare/medicaid/eligibility

Ohio

You may be eligible for Medicaid in Ohio if you are a state resident as well as a U.S. citizen or legal non-resident. You must also belong to one of the following groups:

Individuals with low incomes
Pregnant women, infants and children
Older adults
Parents and caretakers
Individuals with disabilities

Check to see if you meet the Ohio income eligibility guidelines here: https://odh.ohio.gov/wps/wcm/connect/gov/2e3738aa-905a-4325-8839-e1172ca16fa9/2022+Ohio+Medicaid+Guidelines+%28web%29+02.01.22.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N0JO00QO9DDDDM3000-2e3738aa-905a-4325-8839-e1172ca16fa9-nX5WzUj#:~:text=Family%20Size%20Monthly%20Income*%201,not%20have%20private%20health%20insurance.

Oklahoma

In order to qualify for Medicaid in Oklahoma, you should be a resident of the state as well as a U.S. citizen or permanent legal resident. In addition, you should belong to one of the following groups:

Adults with children under 19
Children under 19 and pregnant women
Individuals 65 and older
Individuals who are blind or who have disabilities
Women under 65 in need of breast or cervical cancer treatment
Men and women 19 and older with family planning needs

Check to see if you meet the Oklahoma income eligibility guidelines here: https://oklahoma.gov/ohca/individuals/mysoonercare/apply-for-soonercare-online/eligibility/income-guidelines.html

Oregon

In order to qualify for Medicaid in Oregon, you must be a resident of the state as well as a U.S. citizen or permanent legal resident. In addition, you must belong to an eligible group and meet the following income requirements:

Children – 300 percent of FPL
Low-income adults – 138 percent of FPL
Pregnant women – 190 percent of FPL

Check to see if you meet the Oregon income eligibility guidelines here: https://www.oregon.gov/oha/HSD/OHP/Tools/HPE-Eligibility-Guide.pdf

Pennsylvania

In order to qualify for Medicaid in Pennsylvania, you must be a resident of the state as well as a U.S. citizen or permanent legal resident. In addition, you must belong to one of the following groups:

Adults age 19-64
Aged, blind and disabled individuals
Families with children under age 21

You must also meet the income and resource requirements. In general, your income should fall below 133 percent of the FPL.

Check to see if you meet the income eligibility guidelines for Medicaid in Pennsylvania here: https://www.dhs.pa.gov/Services/Assistance/Pages/MA-General-Eligibility.aspx

Puerto Rico

All Puerto Rico residents below local Puerto Rico poverty level guidelines qualify for Medicaid. These are the income requirements:

Number Of Household Members	Monthly Income Limit
1	$1,247
2	$1,685
3	$2,124
4	$2,561

Rhode Island

In order to qualify for Medicaid in Rhode Island, you must be a resident of the state as well as a U.S. citizen or permanent legal resident. In addition, you must belong to one of the following groups:

Adults with children 18 or younger
Pregnant women
Adults 65 years of age or older
Adults with Special Needs

You must also meet the income requirements:

Group	Income Limit
Parents and caretakers	133 percent of FPL
Pregnant women	253 percent of FPL
Children	261 percent of FPL
Adults	133 percent of FPL

Check to see if you meet the income eligibility guidelines for Medicaid in Rhode Island here: https://dhs.ri.gov/programs-and-services/energy-and-water-assistance-programs/ffy-2024-low-income-guidelines

South Carolina

In order to qualify for Medicaid in South Carolina, you must be a resident of the state as well as a U.S. citizen or permanent legal resident. In addition, you must belong to one of the following groups:

Children
Pregnant women
Parents and caretakers
Women with breast or cervical cancer
Disabled children
Seniors, blind and disabled adults
Former foster care adults

Check to see if you meet the income eligibility guidelines for Medicaid in South Carolina here: https://www.scdhhs.gov/members/program-eligibility-and-income-limits

South Dakota

In order to qualify for Medicaid in South Dakota, you must be a resident of the state as well as a U.S. citizen or permanent legal resident. In addition, you must belong to one of the following groups:

Low-income families
Children
Pregnant women
Disabled children
Women with breast or cervical cancer
Workers with disabilities
Disabled adults
Individuals in adult foster care facilities
Individuals in assisted living facilities
Elderly individuals
Refugees
Former foster care youth

Check to see if you meet the income guidelines for Medicaid in South Dakota by using the eligibility screening tool here: https://eaportal.sd.gov/UniversalAccess/eligibility

Tennessee

In order to qualify for Medicaid in Tennessee, you must be a resident of the state as well as a U.S. citizen or permanent legal resident. In addition, you must belong to one of the following groups:

Children under 19
Pregnant women
Parents and caretakers of children
Women with breast or cervical cancer
People who get SSI
Institutionalized individuals
Medically needy children up to age 21

Check to see if you meet the Tennessee income eligibility guidelines here: https://www.tn.gov/content/dam/tn/tenncare/documents/eligibilityrefguide.pdf

Texas

In order to qualify for Medicaid in Texas, you must be a resident of the state as well as a U.S. citizen or permanent legal resident. In addition, you must belong to one of the following groups:

Low-income families
Pregnant women
Parents and caretakers
Children
Aged, disabled and blind individuals
Former foster care recipients

You must also meet the income eligibility requirements where applicable:

Group	Income Limit	Asset Limit
Children	133 percent of FPL	None
Transitioning foster care youth, 18-20	413 percent of FPL	None
Pregnant women	198 percent of FPL	None
Working with disabilities	230 percent of FPL	$2,000
Children with disabilities	147 percent of FPL	None

Check to see if you meet the Texas income eligibility guidelines here: https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-programs-services/programs-children-families/medicaid-parents-caretakers

U.S. Virgin Islands

The U.S. Virgin Islands use local poverty levels to determine eligibility.

Individuals are eligible for Medicaid in the U.S. Virgin Islands if they fall below 133 percent of the USVI poverty level, which is equivalent to 102 percent of the FPL.

Disabled, blind and aged individuals can qualify with incomes up to 177 percent of the USVI poverty level, equivalent to 165 percent of the FPL.

U.S. Virgin Islands

Apply using the Medicaid Application. Download the form here: https://www.dhs.gov.vi/financial_programs/documents/RevisedMedicaidApplication002.pdf
For questions about the application process, contact the Call Center at (340) 715-6929 or vimmis@dhs.vi.gov.

Utah

In order to qualify for Medicaid in Utah, you must be a resident of the state as well as a U.S. citizen or permanent legal resident. In addition, you must belong to one of the following groups:

Low-income families
Pregnant women
Parents and caretakers
Children
Aged, disabled and blind individuals
Women with breast or cervical cancer

You must have a household income below 133 percent of the FPL in general.

Check to see if you meet the Utah Income eligibility guidelines here: https://medicaid.utah.gov/ufaq/what-are-the-income-guidelines/

Vermont

In order to qualify for Medicaid in Vermont, you must be a resident of the state as well as a U.S. citizen or permanent legal resident. In addition, you must belong to one of the following groups:

Low-income adults
Pregnant women
Parents and caretakers
Children
Aged, disabled and blind individuals

You must also meet the income requirements:

Group	Income Limit
Children	312 percent of FPL
Pregnant women	208 percent of FPL
Adult	133 percent of FPL
Working while disabled	250 percent of FPL
Aged, disabled	400 percent of FPL

Check to see if you meet the Utah Income eligibility guidelines here: https://info.healthconnect.vermont.gov/compare-plans/2024-eligibility-tables

Virginia

In order to qualify for Medicaid in Virginia, you must be a resident of the state as well as a U.S. citizen or permanent legal resident. In addition, you must belong to one of the following groups:

Pregnant women
Parents and caretakers of children 18 years of age or younger
Children 18 years of age or younger
Aged, disabled and blind individuals

You must meet the income requirements:

Group	Income Limit
Children	148 percent of FPL
Pregnant women	148 percent of FPL
Adults	138 percent of FPL
Aged, blind and disabled individuals	80 percent of FPL
Working disabled	80 percent of FPL

Check to see if you meet the Virginia Income eligibility guidelines here: https://coverva.dmas.virginia.gov/learn/coverage-for-adults/adults-19-64-years-old/

Washington

In order to qualify for Medicaid in Washington, you must be a resident of the state as well as a U.S. citizen or permanent legal resident. You must belong to one of the following groups:

Low-income adults
Very low-income parents or caretakers
Pregnant women
Children
Aged, blind or disabled individuals
Low-income Medicare recipients
Former foster children

You must also meet the applicable income requirements:

Group	Income Limit
Adults 19-64 years old	138 percent of FPL
Parents or caretakers	48 percent of FPL
Pregnant women	198 percent of FPL
Children	215 percent of FPL
Aged, Blind and Disabled	74 percent of FPL

Check to see if you meet the Washington Income eligibility guidelines here: https://www.hca.wa.gov/free-or-low-cost-health-care/i-need-medical-dental-or-vision-care/eligibility-overview

West Virginia

In order to qualify for Medicaid in West Virginia, you must be a resident of the state as well as a U.S. citizen or permanent legal resident. In addition, you must belong to one of the following groups:

Children 18 years of age or younger
SSI beneficiaries
Very low-income families
Pregnant women
Seniors
Blind and disabled individuals
Women with breast or cervical cancer

In some cases, in order to get Medicaid in West Virginia, you must also meet the income requirements:

Group	Income Limit
Children 0-1	163 percent of FPL
Children 1-6	146 percent of FPL
Children 6-19	138 percent of FPL
Pregnant women	190 percent of FPL
Adults 19-65	138 percent of FPL

Check to see if you meet the guidelines for Medicaid in West Virginia by clicking the “Health Care” checkbox on the prescreening tool here: https://www.wvpath.org/benefitsfinderWV

Wisconsin

In order to qualify for Medicaid in Wisconsin, you must be a Wisconsin resident and U.S. citizen or permanent legal resident. You must also belong to one of the following groups:

Children 18 years of age or younger
Seniors
Low-Income adults
Pregnant women
People with disabilities

You must also meet the income and asset requirements for individual programs. Income limits can range from under 100 percent of FPL to 300 percent of FPL, depending on what program you are eligible for.

Check to see if you meet the Wisconsin Income eligibility guidelines here: https://www.dhs.wisconsin.gov/medicaid/fpl.htm

Wyoming

In order to qualify for Medicaid in Wyoming, you must be a Wyoming resident and a U.S. citizen or permanent legal resident. You must also belong to one of the following groups:

Children
Pregnant women
Aged, blind or disabled individuals
Parents or caretakers
Women with breast or cervical cancer

In order to qualify for Medicaid in Wyoming, you must also meet the following eligibility requirements:

Group	Income	Assets
Children 0-5	154 percent of FPL	None
Children 6-18	133 percent of FPL	None
Pregnant women	154 percent of FPL	None
Aged, Blind or Disabled – Inpatient Care	300 percent of FPL	1 person – $2,0002 people – $3,000
Qualified Medicare Beneficiary	135 percent of FPL	1 person – $7,8602 people – $11,800
Specified Low-Income Medicare Beneficiary	135 percent of FPL	1 person – $7,8602 people – $11,800
Parent or caretaker	50 percent of FPL	None
Women with breast or cervical cancer	250 percent of FPL	None
Working with disabilities	300 percent of FPL	None

Check to see if you meet the Wisconsin Income eligibility guidelines here: https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/medicaid-income-requirements/

How to Apply for Medicaid

person checking box on a form applying for medicaid

In order to receive Medicaid benefits, you must submit an application with your state’s Medicaid office. Learn more about applying for Medicaid in the sections below.

When can you apply for Medicaid?

Unlike programs like Medicare or the Health Insurance Marketplace, you can apply for Medicaid benefits any time of year.

Documents Needed to Complete a Medicaid Application

To apply for Medicaid, you may need any of the following documents:

The Social Security Number (SSN) or document number of all members of your household
All employer and income documentation for all members of your household (including W-2s, 1099s and other wage and tax statements)
Bank statements

Your state’s Medicaid application form will explain the exact documentation required to apply. Learn more in the section “How To Apply For Medicaid By State and Territory” of this guide.

Information Needed to Complete a Medicaid Application

To submit an application for Medicaid, you must complete an application form and may need to provide the following information for yourself and all other members of your household:

Your name
Your contact information
Your address
Your Social Security Number (SSN)
The health insurance coverage you seek
Your residency status
Your citizenship status
Your employment status
Your household income
Your household finances
Your household property
Your health insurance status
Your tribal status
Your veteran status
Your current medical needs
Your current expenses
Your current benefits

Your state’s Medicaid application form will explain the exact information required in your state. Learn more in the section “How To Apply For Medicaid By State and Territory” on of this guide.

Medicaid Application Process

Depending on where you live, you may be able to apply for Medicaid in the following ways:

Online
- When applying online, you can either apply directly with the federal government’s Health Insurance Marketplace (https://www.healthcare.gov/medicaid-chip/) or your state’s Medicaid website.
In person
By phone
By mail
By fax
By email

Continue reading the section below to find the application methods available in each state. If you are a member of a federally recognized tribe, refer to the state wherein your tribe is located to learn how to apply.

How to Apply for Medicaid by State and Territory

To receive Medicaid benefits, you must submit a complete application through the Health Insurance Marketplace (https://www.healthcare.gov/medicaid-chip/) or with your state Medicaid agency. Learn how to apply for Medicaid by finding your state or territory in the list below.

Alabama

Apply online through Insure Alabama: https://insurealabama.adph.state.al.us
Apply by mail using the Application for Health Coverage & Help Paying Costs. Download and print the form here: https://medicaid.alabama.gov/content/9.0_Resources/9.4_Forms_Library/9.4.1_Applicant_Forms.aspx

If you cannot download the form, you can pick up a paper application at your local health department. Find a list of locations here: https://medicaid.alabama.gov/content/10.0_Contact/10.1_Medicaid_Contacts/10.1.1_Medicaid_Locations.aspx

When completed, mail the application to:
ALL Kids Program
P.O. Box 304839
Montgomery, AL 36130-4839

Alaska

Apply online through the Alaska Self-Service portal: https://aries.alaska.gov/screener/?logIn=N

Apply using the Application for Services. Download and print the form here: http://dpaweb.hss.state.ak.us/e-forms/pdf/GEN-50C.pdf

If you cannot download the form, you can request a paper application at your local Public Assistance Office. Find a list of offices here: https://dhss.alaska.gov/dpa/Pages/contacts.aspx

When the application is complete, mail or drop it off at your local Public Assistance Office.

Apply by phone by calling (800) 478-7778.

American Samoa

Contact the American Samoa Medicaid State Agency to learn how to apply:

By phone: 1 (684) 699-4777
By email: omr@medicaid.as.gov
By mail:
ASTCA Executive Building #306
P.O. Box 6101
Pago Pago, AS 96799
By fax: 1 (684) 699-4780

Arizona

Apply online through the Health-e-Plus Arizona portal: https://www.healthearizonaplus.gov/Login/Default

Apply by mail using a paper application. If you are over age 65, blind or disabled, use the Application for AHCCCS Medical Assistance and Medicare Savings Programs in English (https://www.azahcccs.gov/Members/Downloads/DE103.pdf) or Spanish (https://www.azahcccs.gov/Members/Downloads/DE103sp.pdf) and mail the completed form to:
AHCCCS Medical Assistance Specialty Programs
801 East Jefferson Street
Phoenix, AZ 85034

All other applicants can use the Application for Benefits in English (https://des.az.gov/sites/default/files/dl/FAA-0001A.pdf) or Spanish (https://des.az.gov/sites/default/files/dl/FAA-0001A-S.pdf) and mail the completed form to:
Arizona Department of Economic Security Family Assistance Administration
P.O. Box 19009
Phoenix, AZ 85005

Apply in person at your local DES Family Assistance Administration office. Find a list of locations here: https://des.az.gov/find-your-local-office

Arkansas

Apply online through Access Arkansas: https://access.arkansas.gov

Apply in person at the Department of Human Services (DHS) office in your county of residence. Find a map of locations here: https://humanservices.arkansas.gov/contact-us/county-office-map/

Apply using a Household Health Coverage Application. Download and print the form here: https://humanservices.arkansas.gov/wp-content/uploads/DCO-0152Combined.pdf

When the application is complete, mail it to:
DHS Pine Bluff Scanning Center
P.O. Box 8848
Pine Bluff, AR 71611-8848

Fax the form to 1-870-534-3421Email the form to 351Jefferson@arkansas.gov.

Drop the form off at your local DHS office.

California

Apply online through Covered California: https://www.coveredca.com/apply/apply-online/

Apply by mail using the Application for Health Insurance. Download and print the form here: https://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/2014_CoveredCA_Applications/ENG-CASingleStreamApp.pdf

When the application is complete, mail it to:
Covered California
P.O. Box 989725
West Sacramento, CA 95798-9725

Apply in person at your local County Social Services Office. Find a list of locations here: https://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx

Colorado

Apply online through Colorado PEAK: https://coloradopeak.secure.force.com

Apply by mail using the Health First Colorado paper application. Download and print the form here: https://hcpf.colorado.gov/sites/hcpf/files/Health%20First%20Colorado%20-%20Child%20Health%20Plan%20Plus%20Application%20-%20English.pdf

When the application is complete, mail it to:
Connect for Health Colorado
P.O. Box 35681
Colorado Springs, CO 80935

You can also mail it or drop it off at any Department of Human Services (DHS) office. A list of locations can be found on pages 37-40 of the application, or on the DHS website here: https://www.colorado.gov/cdhs/contact-your-county

Apply by phone at 1 (800) 221-3943 or State Relay at 711.

Apply in person at your local county DHS office or at an application assistance site. Find a list of application assistance offices here: https://apps.colorado.gov/apps/maps/hcpf.map

Commonwealth of Northern Mariana Islands

Apply using the Application for Medical Assistance for the Needy. You can pick one up at the Medicaid office or download it here: https://medicaid.cnmi.mp/images/CNMI-images/PDFdocs/2019-09-04-Medicaid_Application_Form.pdf
- When the form is complete, return it to:
  Government Bldg. No. 1252
  Capitol Hill Rd. Caller Box 10007
  Saipan, MP 96950

Connecticut

Apply online through Access Health CT: https://www.accesshealthct.com/AHCT/cthix/#/home
Apply by phone at 1 (855) 805-4325.
Apply in person at your local Department of Social Services (DSS) office. Find a list of locations here: https://portal.ct.gov/dss/About-the-Department-of-Social-Services/Contact
Apply using paper application form AH3, available by calling Access Health CT at 1 (855) 805-4325. You can drop the form off or mail it to any DSS office.

Delaware

Apply online through the ASSIST portal: https://signup.assistselfservice.dhss.delaware.gov/?destination=0
Apply by mail using a paper application, which will be mailed to your home address. Call 1 (800) 372-2022 or (302) 255-9500 to be directed to the Division of Social Services (DSS) office closest to where you live. Appropriate application forms will be mailed to you.
- Complete, sign and date the application form in ink and mail it to the address provided on the form.

District of Columbia

Apply online through DC Health Link: https://www.dchealthlink.com
Apply using the Standard Application for Health Coverage & Help Paying Costs for Families (https://www.dchealthlink.com/sites/default/files/v2/forms/DC_Health_Link_Standard_Application_for_Help_Paying_for_Health_Coverage_201509.pdf) or individuals (https://www.dchealthlink.com/sites/default/files/v2/forms/DC_Health_Link_Application_for_Help_Paying_for_Health_Coverage_Short_201509.pdf)
- When the form is complete, either:
  - Mail it to:
    DC Health Link
    DHS Case Records Management Unit
    P.O. Box 91560
    Washington, DC 20090
  - Fax it to: (202) 671-4400.
Apply by phone at 1 (855) 532-5465.
Apply in person at any ESA service center. Find a list of locations here: https://dhcf.dc.gov/service/how-apply-medical-coverage

Florida

Apply online through the ACCESS Florida portal: https://dcf-access.dcf.state.fl.us/access/scrflstartappl.do?performAction=init&showMensaje=true
Apply using the Family-Related Medicaid Application. Download the form here (https://palmbeach.floridahealth.gov/programs-and-services/clinical-and-nutrition-services/registration-forms-clinic-services/_documents/medicaid-application-english.pdf), print it out, complete it and mail it to:
ACCESS Central Mail Center
P.O. Box 1770
Ocala, Florida 34478-1770

Georgia

Apply online through the Georgia Gateway portal: https://gateway.ga.gov/access/accessController?id=427a056ba982d864d159d2eec
Apply in person at any Division of Family and Children Services office. Find a list of locations here: https://dfcs.georgia.gov/locations
Apply by phone at 1 (877) 423-4746.
Apply using Form 94A. Download the form here (https://dfcs.georgia.gov/services/how-do-i-apply-medicaid), print it, complete it and mail it to:
Division of Family and Children Services
Customer Contact Center
P.O. Box 4190
Albany, GA 31706

Hawaii

Apply online through the Med-QUEST portal: https://medical.mybenefits.hawaii.gov/web/kolea/home-page
Apply by phone at 1 (800) 603-1201 (toll-free), 1 (800) 316-8005 (toll-free TTY) or 711.
Apply using the Application for Health Coverage & Help Paying Costs form. Download the form here: https://medquest.hawaii.gov/content/dam/formsanddocuments/client-forms/1100-application-for-health-coverage—help-paying-costs/DHS_1100_Rev_12_17_v_4_FINALfillable.pdf/jcr:content?type=pdf&submitUrl=&process=
- When the form is complete, mail or fax it to one of the Med-QUEST eligibility units provided on page 9 of the application. You can also find a map of locations here: https://medquest.hawaii.gov/en/contact-us.html

Idaho

Apply online using the Idalink portal: https://idalink.idaho.gov
Apply by phone at 1 (877) 456-1233.
Apply in person at any field office. Find a list of locations here: https://healthandwelfare.idaho.gov/offices
Apply using the Application for Health Coverage Assistance. Download the form here: https://healthandwelfare.idaho.gov/FoodCashAssistance/HealthCoverageAssistance/HealthCoverageApplications/tabid/2883/Default.aspx

When the form is complete, you can either:

- Mail it to:
  Self-Reliance Programs – Statewide Application Team
  PO Box 83720
  Boise, ID 83720-0026
- Fax it to 1-866-434-8278
- Email it to: MyBenefits@dhw.idaho.gov

Illinois

Apply online through the Application for Benefits Eligibility (ABE) portal: https://abe.illinois.gov/abe/access/
Apply with a paper application. Download the form here: https://www.dhs.state.il.us/onenetlibrary/12/documents/Forms/IL444-2378B-IES.pdf
- When the form is complete, mail, fax or drop it off at any Family Community Resource Center (FCRC). Find a list of locations here: https://www.dhs.state.il.us/page.aspx?module=12
Apply in person at any FCRC.

Indiana

Apply online through the FSSA Benefits Portal: https://fssabenefits.in.gov/bp/#
Apply in person at your local Division of Family Resources (DFR) office. Find a list of locations here: https://www.in.gov/fssa/dfr/2999.htm
Apply by phone at 1 (800) 403-0864.

Iowa

Apply online through the DHS Services Portal: https://hhsservices.iowa.gov/apspssp/ssp.portal
Apply using the Application for Health Coverage and Help Paying Costs: https://dhs.iowa.gov/sites/default/files/470-5170.pdf?082420201334 (English)
https://dhs.iowa.gov/sites/default/files/470-5170S.pdf?082620201830 (Spanish)
When the form is complete, mail it to:
Imaging Center 4
PO Box 2027
Cedar Rapids, Iowa 52406

Kansas

Apply online through the Medical Consumer Self-Service Portal: https://cssp.kees.ks.gov/apspssp/
Apply using a paper application.
- Pregnant women and families with children and can download the application here: https://www.kancare.ks.gov/docs/default-source/consumers/apply/families-and-children/kc-1100-families-with-children-medical-assistance-application-1-23.pdf?sfvrsn=445c531b_2
- Adults 65 years of age or older or individuals with disabilities can download the application here: https://www.kancare.ks.gov/docs/default-source/consumers/apply/elderly-and-disabled/kc-1500-elderly-and-persons-with-disabilities-medical-assitance-application_1-23.pdf?sfvrsn=8b5c531b_2

When the form is complete, fax it to the following numbers depending on your status:
If you are 65 years of age or older or have a disability, mail or fax your complete application to:
KanCare Clearinghouse
P.O. Box 3599
Topeka, KS 66601-9738
844-264-6285 (fax)

All others should mail or fax the complete application to:
KanCare Clearinghouse
P.O. Box 3599
Topeka, KS 66601-9738
800-498-1255 (fax)

Kentucky

Apply online through the Benefind Portal: https://benefind.ky.gov
Apply by phone at (855) 306-8959.

Louisiana

Apply online through the Online Application portal: https://sspweb.lameds.ldh.la.gov/selfservice/
Apply in person at a Medicaid Application Center. Find a list of locations here: https://ldh.la.gov/index.cfm/page/262
Not all centers accept walk-ins. Call your local center before visiting.
Apply using the Application for Health Coverage. Download the form here: https://ldh.la.gov/assets/medicaid/MedicaidEligibilityForms/MedicaidApplicationPub.pdf
- When the form is complete, mail or fax it to:
  Medicaid Application Office
  P.O. Box 91278
  Baton Rouge, LA 70821-9893
  1 (877) 523-2987 (fax)

Maine

Apply online through My Maine Connection: https://www1.maine.gov/benefits/account/login.html
Apply using the MaineCare application. Download the form here: https://www.maine.gov/dhhs/ofi/applications-forms
- When the form is complete, fax it to (207) 778-8429, email it to Farmington.DHHS@Maine.gov or mail it to:
  Office for Family Independence
  114 Corn Shop Lane
  Farmington, ME 04938
Apply in person at a DHHS office. Find a list of locations here: https://www.maine.gov/dhhs/about/contact/offices

Maryland

Apply online through Maryland Health Connection: https://www.marylandhealthconnection.gov
Apply by phone at 1 (855) 642-8572 or 1 (855) 642-8573 (TTY).
Apply in person at a Connector Entity (find locations here: https://www.marylandhealthconnection.gov/assets/Connector-Entity-Contact-Sheet.pdf), your local health department (find locations here: https://health.maryland.gov/Pages/departments.ASPX) or a Department of Social Services office (find locations here: https://mydhrbenefits.dhr.state.md.us/dashboardClient/#/dssMap)
Apply through the Enroll MHC mobile app. Download it here: https://www.marylandhealthconnection.gov/enrollmhc/

Massachusetts

Apply online through Massachusetts Health Connector: https://www.mahealthconnector.org
Apply using the Massachusetts Application for Health and Dental Coverage and Help Paying Costs: https://www.mass.gov/doc/massachusetts-application-for-health-and-dental-coverage-and-help-paying-costs-0/download
- When the form is complete, mail or fax it to:
  Health Insurance Processing Center
  P.O. Box 4405
  Taunton, MA 02780.
  (857) 323-8300 (fax)
Apply by phone at (800) 841-2900 or (800) 497-4648 (TTY) Monday through Friday, 8 a.m. to 5 p.m.
Apply in person at a MassHealth Enrollment Center (MEC) Monday through Friday, 8:45 a.m. to 5 p.m.. Find a list of locations here: https://www.mass.gov/service-details/masshealth-enrollment-centers-mecs

Michigan

Apply online through MI Bridges: https://newmibridges.michigan.gov/s/isd-landing-page?language=en_US
Apply by phone at 1 (855) 789-5610.
Apply in person at your local Department of Human Services office. Find a map of locations here: https://www.michigan.gov/healthymiplan/0,5668,7-326-67920—,00.html

Minnesota

Apply online through MNSure: https://auth.mnsure.org/RIDP/?account_type=Individual
Apply using the MNSure paper application. Download the form here: https://edocs.dhs.state.mn.us/lfserver/Public/DHS-6696-ENG
- When the form is complete, mail it to one of the agency addresses found at the bottom of the application.

Mississippi

Apply online through Access Mississippi: https://www.access.ms.gov
Apply using the Mississippi Application for Health Benefits. Request a form be mailed to you by calling (800) 421-2408. Or, download the form here: https://medicaid.ms.gov/wp-content/uploads/2017/10/DOM_MAGIApp.pdf
- When the form is complete, mail it to the Mississippi Medicaid Regional Office that serves your county. Find a list of locations here: https://medicaid.ms.gov/about/office-locations/
- Or, fax the completed application to 601-576-4164
Apply in person at a Mississippi Medicaid Regional Office.

Missouri

Apply online through MyDSS: https://mydss.mo.gov/healthcare/apply
Apply using the Application for MO Healthnet. Download the form here: https://dssmanuals.mo.gov/wp-content/uploads/2020/09/IM-1SSL-Fillable-Secured-6-24-21.pdf
- When the form is complete, mail or fax it to:
  Greene County FSD
  101 Park Central Square
  Springfield, MO 65806
  (417) 895-6080 (fax)

Montana

Apply online through the portal: https://apply.mt.gov/access/accessController?id=0.0457682247476211
Apply by phone at 1 (800) 318-2596
Apply in person at a Field Office of Public Assistance. Find a list of locations here: https://dphhs.mt.gov/hcsd/OfficeofPublicAssistance

Nebraska

Apply online through the portal: https://apply.mt.gov/access/accessController?id=0.0457682247476211
Apply by phone at 1 (800) 318-2596.
Apply in person at a Field Office of Public Assistance. Find a list of locations here: https://dphhs.mt.gov/hcsd/OfficeofPublicAssistance

Nevada

Apply online through ACCESS Nevada: https://accessnevada.dwss.nv.gov
Apply using the Application for Health Insurance. Download the form here: https://dwss.nv.gov/uploadedFiles/dwssnvgov/content/Home/Features/Forms/2960-EG_Application%20for%20Health%20Insurance.pdf
- When the form is complete, mail it to your local welfare office. Find a list of Northern Offices here (https://dwss.nv.gov/Contact/Welfare_District_Offices-North/) and Southern offices here (https://dwss.nv.gov/Contact/Welfare_District_Offices-South/). You can also mail it to the DWSS state office at:
  DWSS
  P.O. Box 15400
  Las Vegas, NV 89114

New Hampshire

Apply online through the NH EASY portal: https://nheasy.nh.gov/#/
Apply using the Application for Health Coverage & Help Paying Costs. Download the form here: https://nheasy.nh.gov/forms/E/800MA.pdf
- When the form is complete, mail or fax it to:
  Central Medicaid Unit
  129 Pleasant Street
  Concord, NH 03301
  (603) 271-8604
- Or, mail it to your local District Office. Find a list of offices here: https://www.dhhs.nh.gov/about-dhhs/locations-facilities
Apply by phone at 1-800-852-3345 ext. 9700.

New Jersey

Apply online through NJ Family Care: https://www.njfamilycare.org
Apply using the Application for Health Coverage & Help Paying Costs. Download the form here: https://www.njfamilycare.org/docs/FC_APP-en.pdf
- When the form is complete, mail it to:
  NJ FamilyCare
  P.O. Box 8367
  Trenton, NJ 08650-9802
Apply in person at your local County Board of Social Services. Find a list of locations here: https://www.nj.gov/humanservices/njsnap/home/cbss.shtml

New Mexico

Apply online through the Yes NM portal: https://www.yes.state.nm.us/yesnm/home/index
Apply using the Application for Assistance. Download the form here: https://www.hsd.state.nm.us/wp-content/uploads/HSD-100-English-revised-1.pdf
- When the form is complete, mail or fax it to:
  Central ASPEN Scanning Area (CASA)
  P.O. Box 830
  Bernalillo, NM 87004
  (855) 804-8960 (fax)
Apply by phone at (855) 637-6574.

New York

Apply online through the NY State of Health Marketplace: https://nystateofhealth.ny.gov/individual
Apply by phone at (800) 541-2831.
Apply with a Certified Application Counselor or Navigator. Access the directory here: https://info.nystateofhealth.ny.gov/sites/default/files/August%202020%20Statewide%20Phone%20Enrollment%20Directory.pdf
Apply in person at your local Department of Social Services (DSS). Find a list of locations here: https://www.health.ny.gov/health_care/medicaid/ldss.htm

North Carolina

Apply online through ePASS: https://epass.nc.gov
Apply using the Application for Health Coverage & Help Paying Costs. Download the form here: https://policies.ncdhhs.gov/wp-content/uploads/dhb-5200-ia-9-2020.pdf
- When the form is complete, mail or drop it at your local Division of Social Services office (DSS). Find a list of locations here: https://www.ncdhhs.gov/divisions/social-services/local-dss-directory
Apply in person at a DSS office.
Apply by phone by calling your local DSS office.

North Dakota

Apply online with the North Dakota DHS: https://dhsbenefits.dhs.nd.gov
Apply using the Application for Health Coverage & Help Paying Costs. Download the form here: https://apps.nd.gov/itd/recmgmt/rm/stFrm/eforms/Doc/sfn01909.pdf
- When the form is complete, mail it to:
  ND DHS
  600 East Boulevard Avenue Dept. 325
  Bismarck, ND 58505
  Or, mail it to your local Human Service Zone (also known as County Social Service Office). Find a list of locations here: https://www.hhs.nd.gov/human-service/zones

Ohio

Apply online through the Ohio Benefits portal: https://benefits.ohio.gov
Apply in person at a Job and Family Services Office. Find a list of locations here: https://jfs.ohio.gov/County/County_Directory.pdf
Apply by phone at (800) 324-8680.

Oklahoma

Apply online through the Health Care Authority: https://www.apply.okhca.org/Site/UserAccountLogin.aspx
Apply using the Application for Health Coverage & Help Paying Costs. Download the form here: https://marketplace.cms.gov/applications-and-forms/marketplace-application-for-family.pdf
- When the form is complete, mail it to:
  Health Insurance Marketplace
  Dept. of Health and Human Services
  465 Industrial Blvd.
  London, KY 40750-0001

Oregon

Apply online through the OregONE portal: https://one.oregon.gov
Apply using the Application for Health Plan Benefits. Download the form here: https://www.oregon.gov/oha/HSD/OHP/Pages/apply.aspx#apps
- When the form is complete, mail or fax it to:
  OHP Customer Service
  P.O. Box 14015
  Salem, OR 97309-5032
  (503) 378-5628 (fax)
Apply in person at a Department of Human Services (ODHS) office. Find offices near you here: https://www.oregon.gov/odhs/Pages/office-finder.aspx

Pennsylvania

Apply online through the COMPASS portal: https://www.compass.state.pa.us/compass.web/Public/CMPHome
Apply by phone at 1 (866) 550-4355
Apply using the Pennsylvania Application for Benefits. Download the form here: https://www.dhs.pa.gov/Services/Assistance/Documents/Benefits%20Applications/PA%200600-8-23-Final-uf.pdf
- When the form is complete, mail, fax or drop it off to your local County Assistance Office (CAO). Find a list of locations here: https://www.dhs.pa.gov/Services/Assistance/Pages/CAO-Contact.aspx
Apply in person at your local CAO.

Rhode Island

Apply online through HealthSource RI: https://healthsourceri.com/how-to-enroll/
Apply in person at your local Department of human Services (DHS) office. Find a list of locations here: https://dhs.ri.gov/office-locator-tool
Apply by phone at 1 (855) 840-4774.

South Carolina

Apply online through South Carolina Healthy Connections: https://apply.scdhhs.gov/CitizenPortal/application.do
Apply using the Application for Medicaid and Affordable Health Coverage. Download the form here: https://www.scdhhs.gov/sites/default/files/FM%203400.pdf
When the form is complete, return it in one of the following ways:
- Email it to 8888201204@fax.scdhhs.gov
- Mail it to
  SCDHHS-Central Mail
  P.O. Box 100101
  Columbia, SC 29202-3101
- Mail it to your local county office. Find a list of locations here: https://www.scdhhs.gov/site-page/where-go-help
Apply in person at your local county office.

South Dakota

Apply online through DSS South Dakota: https://apps.sd.gov/ss36snap/web/Portal/Default.aspx
Apply using the Application for Medicaid/CHIP, Health Coverage & Help Paying Costs. Download the form here: https://dss.sd.gov/formsandpubs/docs/MEDELGBLTY/FSSA.pdf
- When the form is complete, mail it to your local DSS office. Find a list of locations here: https://dss.sd.gov/findyourlocaloffice/

Tennessee

Apply online through YourTexasBenefits: https://www.yourtexasbenefits.com/Learn/Home
Apply using the paper application. Download the form or request a form by mail here: https://www.yourtexasbenefits.com/Learn/GetPaperForm
- When the form is complete, return it in one of the following ways:
- Mail it to:
  HHSC
  P.O. Box 149024
  Austin, TX 78714-9968
- Fax it to 1 (877) 447-2839
- Drop it off at a benefits office. Search for your nearest office here https://hhs.texas.gov/about-hhs/find-us/where-can-i-find-services or call 2-1-1
Apply in person at a Community Partner Program. Find a location here: https://www.texascommunitypartnerprogram.com
Apply by phone Monday through Friday, 8:00 AM to 6:00 PM, at 1-877-541-7905 or 2-1-1

Utah

Apply online through myCase: https://jobs.utah.gov/mycase/
Apply using the Medical Application. Download the form here: https://medicaid.utah.gov/Documents/pdfs/61MED_English.pdf
- When the form is complete, return it in one of the following ways:
  - Mail it to:
    Department of Workforce Services
    PO Box 143245
    Salt Lake City, UT 84114-3245
  - Fax it to (801) 526-9505
  - Bring it to a Department of Workforce Services (DWS) office. Search for an office near you here: https://jobs.utah.gov/jsp/officesearch/#/map
Apply in person at a DWS office.

Vermont

Apply online through Vermont Health Connect: https://vermonthealthconnect.gov
Apply using the Application for Health Coverage & Help Paying Costs. Download the form here: https://info.healthconnect.vermont.gov/sites/vhc/files/doc_library/205ALLMED%20Non-LTC%20%282023%29.pdf or call 1 (855) 899-9600 to have one mailed to you.
- When the form is complete, mail it to:
  Vermont Health Connect
  Application and Document Processing Center
  280 State Drive
  Waterbury, VT 05671-8100
Apply by phone at 1 (855) 899-9600.
Apply in person with an assister. Find one near you here: https://info.healthconnect.vermont.gov/find-local-help/find

Virginia

Apply through the Virginia CommonHelp portal: https://www.commonhelp.virginia.gov
Apply using the Application for Health Coverage & Help Paying Costs. Download the form here: https://www.dmas.virginia.gov/media/rgaedgrg/magi-standard-application-final-03-01-2024.pdf
- When the form is complete, mail or drop it off at your local Department of Social Services (DSS) office. Find a list of locations here: https://www.dss.virginia.gov/localagency/
Apply by phone at 1 (855) 242-8282 or 1 (888) 221-1590 (TTD) Monday through Friday, 8 a.m. to 7 p.m., and Saturday 9 a.m. to 12 p.m.

Washington

Adults who are blind, disabled or 65 years of age or older can apply in the following ways:
1. Online through Washington Connection: https://www.washingtonconnection.org/home/
2. Using the Apple Health Application. Download the form here https://www.hca.wa.gov/assets/free-or-low-cost/18-005.pdf or call 1-877-501-2233 to request one by mail.
  - When the form is complete, return it in one of the following ways:
    - Mail it to:
      DSHS
      Community Services Division – Customer Service Center
      P.O. Box 11699
      Tacoma, WA 98411-6699
    - Fax it to 1 (888) 338-7410
    - Bring it to your local DSHS office. Find a list of locations here: https://www.dshs.wa.gov/office-locations
    - In person at your local DSHS office
All other applicants can apply in the following ways:
1. Online through Washington Healthplanfinder: https://www.wahealthplanfinder.org/_content/applynow.html
2. Using the WAPlanfinder Mobile App. Download it here: https://www.wahbexchange.org/mobile/
3. Using the Application for Health Care Coverage. Download the form here: https://www.hca.wa.gov/assets/free-or-low-cost/18-001P.pdf
  - When the form is complete, mail it to:
    Washington Healthplanfinder
    P.O. Box 946
    Olympia, Washington, 98507
    You can also fax it to: 1 (855) 867-4467
4. By phone at 1-855-923-4633
5. In person with a Health Benefit Exchange Navigator. Find one near you here: https://www.wahealthplanfinder.org/HBEWeb/Annon_DisplayBrokerNavigatorSearch.action?brokerNavigator=NAV

West Virginia

Apply online through WVPath: https://www.wvpath.org
Apply using the Application for Health Coverage & Help Paying Costs. Download the form here: https://dhhr.wv.gov/bms/Members/Apply/Documents/DFA-SLA-1.pdf
- When the form is complete, mail, fax or bring it to your local DHHR office. Find a list of locations here: https://dhhr.wv.gov/bms/Pages/Field-Offices.aspx
Apply in person at your local DHHR office.
Apply by phone at 1 (877) 716-1212.

Wisconsin

Apply online through ACCESS Wisconsin: https://access.wisconsin.gov/access/
Apply using the Medicaid for the Elderly, Blind or Disabled packet (for adults who are blind, disabled or 65 years of age or older): https://www.dhs.wisconsin.gov/library/F-10101.htm or the BadgerCare Plus packet (for all other applicants): https://www.dhs.wisconsin.gov/forms/f1/f10182.pdf
- When the form is complete, mail it to:
  CDPU
  P.O. Box 5234
  Janesville, WI 53547-5234
  You can also fax it to: (855) 293-1822
  *If you live in Milwaukee County, mail or fax it to:
  MDPU
  P.O. Box 05676
  Milwaukee, WI 53205
  (888) 409-1979 (fax)
Apply by phone by calling your income maintenance or tribal agency. Find a list of contacts here: https://www.dhs.wisconsin.gov/forwardhealth/imagency/index.htm
Apply in person at your income maintenance or tribal agency.

Wyoming

Apply online through the Wyoming Eligibility System (WES): https://www.wesystem.wyo.gov/
Apply using the Application for Health Coverage & Help Paying Costs. Download the form here: https://health.wyo.gov/wp-content/uploads/2016/10/WYStreamlinedApplicationEnglish10032016.pdf
- When the form is complete, either:
- Mail it to:
  WDH Customer Service Center
  2232 Dell Range Blvd. #300
  Cheyenne, WY 82009
- Email it to: wesapplications@wyo.gov
- Fax it to: 1 (855) 329-5205
Apply by phone at 1 (855) 294-2127.

After Applying For Medicaid

In general, it takes up to 45 days for a state to review and approve your application for Medicaid. It can take up to 90 days if you require a disability determination as part of your application. However, the exact time frames may vary by state.

Incomplete applications or missing documents can take longer to process. Check your application and ensure it is complete before submitting it to avoid delays.

Note:

Although it can take up to 90 days for your benefits to be approved, they are retroactive. Once you are approved, your benefits will be approved from the day you applied. This means you will be reimbursed or covered for any eligible medical services you have received after submitting your application.

What happens after you are approved?

After you are approved for Medicaid, you will receive a letter informing you that you were approved. Soon afterwards, you will receive a Medicaid card that you can present as proof of coverage to obtain benefits.

If you require medical treatment after receiving your eligibility letter and before receiving your Medicaid card, you can present the letter as evidence that you qualify for benefits.

How long will your benefits last?

Medicaid benefits are not time-limited. You can continue to receive benefits as long as you remain eligible for them. However, you have to renew your benefits every year in order to continue receiving them. To renew your benefits, you should visit your state agency’s website and submit a renewal.

In the weeks before your renewal deadline, your state will contact you with information about how to renew your Medicaid benefits. Follow the instructions provided to complete the process.

If you experience any changes to your income, household size, disability status, expenses or other relative information, you must report it to your state’s Medicaid agency.

Medicaid Denials and Appeals

Your Medicaid application can be denied for many reasons. If your state or territory’s Medicaid agency believes you do not meet all the eligibility criteria, you will not receive Medicaid benefits. Although you can reapply for Medicaid in the future if your circumstances change, you can also appeal a denial if you believe you are entitled to Medicaid benefits.

Common Reasons for a Denial of Medicaid Benefits

You may be denied Medicaid benefits if you do not meet all of the eligibility criteria outlined by your state or territory’s Medicaid agency. To learn about eligibility criteria in your state or territory, refer to the “Medicaid Eligibility by State and Territory” section of this guide. Here are some of the most common reasons for being denied Medicaid:

Your income exceeds your state or territory’s limit.
You are not part of a covered population in your state or territory.
You are not a legal U.S. resident.
You have not met the five-year waiting period as a qualified non-citizen.

If you are denied Medicaid benefits, your state or territory will generally send you an eligibility determination notice detailing the reason that your application for Medicaid benefits was denied. This notice also describes the appropriate steps to take to file an appeal. This form may have a different name in some states and territories, such as a notice of denial or denial letter.

Requesting an Appeal

In many states and territories, you must request an appeal with the Medicaid agency. Some locations have a request form that you must complete, while others simply require you to send a letter expressing your request to an appeal.

The specific information needed in a written request can typically be found on the state or territory’s Medicaid agency website or webpage.

The information may vary slightly by location, but generally, you can expect to include the following information:

Your full name
- If you are requesting on behalf of your family member, be sure to include both your and your family member’s name.
- If you will be represented by someone other than yourself during a requested hearing, including the representative’s name and phone number in the event the Medicaid agency wishes to contact him or her.
Your home address
- Use the same home address you used on your Medicaid application.
Your phone number
The detailed reason for requesting an appeal
Any supporting documents that may help your case and prove your eligibility for Medicaid
A copy of the eligibility determination notice (if your state or territory sent you one)

How to File an Appeal in Each State and Territory

If you disagree with your denial and believe you qualify for Medicaid, you can appeal your state or territory’s decision. Most agencies require you to submit an appeal within a certain period of time of receiving an eligibility determination notice. The table below outlines these timeframes in each state and territory, as well as the appeal process and how to contact the governing body.

Note:

One asterisk (*) indicates the information is not readily available. Contact your state or territory’s Medicaid agency for more information. Find contact information in the “Medicaid Contact Information By State and Territory” section of this guide.

State	Deadline to Appeal	How to Appeal	Appeals Contact Information
Alabama	Within 60 days of the date listed on the denial notice	File a written request for a fair hearing with the Alabama Medicaid Agency Appeals Office at: PO Box 5624 Montgomery, AL36103-5624	Contact the hotline for assistance at 1 (800) 362-1504 / 1 (800) 253-0799 (TTY) or the Fair Hearings line at 1 (334) 242-5741.
Alaska	Within 30 days of the date listed on the denial notice	File a written request for appeal with the Office of Administrative Hearings by mailing your request to: P. O. Box 240808 Anchorage, AK 99524 Or, file a request via email at: fairhearings@conduent.com Or, file a request via fax at (907) 644-8126	For additional information or assistance, contact the Recipient Helpline at 1 (800) 780-9972 or fairhearings@conduent.com
American Samoa	*	*	*
Arizona	Within 60 days of the date listed on the denial notice	Appeal verbally by phone or in writing to the agency listed on your notice of determination or decision (DES or AHCCCS).	Arizona Health Care Cost Containment System (AHCCCS)(602) 417-4000 Department of Economic Security Phone: (855) 432-7587
Arkansas	Within 30 days of the date listed on the denial notice	Send a letter requesting a fair hearing to: DHS Office of Appeals and Hearings P.O. Box 1437, Slot N401 Little Rock, AR 72203-1437 Fax: (501) 404-4628	DHS Office of Appeals and Hearings Phone: (501) 682-8622
California	Within 60 days of receiving Notice of Action (NOA)	Complete the “Request for State Hearing” on the back of the Notice of Action (NOA) you receive and submit it to one of the following: By mail to the county welfare department at the address shown on the Notice of Action OR By mail to: The California Department of Social Services State Hearings Division P.O. Box 944243Mail Station 21-37 Sacramento, CA 94244-2430 OR By fax to the State Hearings Division by fax: (833) 281-0905 Alternatively, you may request an appeal online here: https://acms.dss.ca.gov/acms/login.request.do Or make a request by phone by calling 1 (800) 743-8525 (voice) / 1 (800) 952-8349 (TDD)	California Department of Social Services: Public Inquiry and Response Phone: 1 (800) 743-8525
Colorado	Within 60 days of the date listed on the denial notice	Complete the Application for Hearing here: https://www.colorado.gov/oac/oac-form-links When complete, mail or fax it to: Office of Administrative Courts (OAC) Denver Office 1525 Sherman Street, 4th Floor Denver, CO 80203 Fax: (303) 866-5909	Office of Administrative Courts (OAC) Phone: 1 (303) 866-2000
Commonwealth of Northern Mariana Islands	*	*	*
Connecticut	Within 60 days of receiving Notice of Action (NOA)	The Notice of Action will include an Appeal Request form and explain how to submit an appeal. Appeal by phone at:1 (800) 859-9889 (you will still have to send an appeal notice in writing) Appeal in by mailing or faxing your appeal form to: State of Connecticut — Department of Social Services (DSS) Office of Legal Counsel Regulation and Administrative Hearings Husky A, C, D and Limited Benefit Appeals 55 Farmington Avenue, 11th floor Hartford, CT 06105 Fax: (860) 424-5729	Member Engagement Services Phone: 1 (800) 859-9889 (Voice) / 711 (TTY for deaf or hard of hearing)
Delaware	Within 5 working days of receiving the notice	You will receive a notice that explains how to submit a request for a fair hearing. Request a fair hearing in writing to: DHSS Herman Holloway Campus, Lewis Building1901 N. DuPont Highway, New Castle, DE 19720	DHSS Phone: (302) 255-9500 or 1 ( 800) 372-2022
District of Columbia	Within 90 days of the postmark on your notice	Download, print and complete the Request for Hearing Form here: https://dhs.dc.gov/sites/default/files/dc/sites/dhs/release_content/attachments/FAIR%20HEARING%20FORM%20-%20English.pdf When complete, fax or email it to: Fax: (202) 724-2041Email: DC.OARA@DC.GOV OR Appeal by phone at: 1 (855) 532-5465 OR Appeal in person at: Administrative Hearings Resource Center441 4th Street NW, Suite 450-North, Washington, DC 20001 Or, appeal in person at any DHS Service Center. Find a list of locations here: https://dhs.dc.gov/service/find-service-center-near-you	Department of Human Services Economic Security Administration Phone: (202) 698-4147
Florida	Within 90 days of receiving Notice of Action (NOA)	Request a fair hearing in one of three ways: Online here: https://ahca.myflorida.com/medicaid/florida-medicaid-complaints/medicaid-fair-hearings OR In writing and send by mail to: Appeal Hearings Section1317 Winewood Blvd., Bldg. 5Tallahassee, FL 32399-0700 OR By phone at 1 (850) 488-1429	Office of Inspector GeneralAppeal Hearings Section Phone: 1 (850) 488-1429 Email: appeal.hearings@myflfamilies.com
Georgia	Within 45 days of the date listed on the notice	Appeal by phone at :1 (877) 423-4746 (Voice) / 1 (800) 255-0135 (TTY) OR Appeal in writing by mail, fax or email to: Right from Start Medical Assistance Group Attn: Eligibility Hearings Coordinator 426 West 12th Street Alma, GA 31510 Fax: (912) 632-0389 Email: RSM.mailfax@dch.ga.gov	Georgia Department of Community Health Phone: (404) 656-4507
Guam	*	*	*
Hawaii	Within 90 days of receiving the notice	Request a review with the Med-QUEST Division by phone at (808) 692-8094. Request a review by mail or fax at: Health Care Services Branch P.O. Box 700190 Kapolei, HI 96709-0190 Fax: (808) 692-8087	Med-QUEST Division Call the Med-QUEST unit nearest you. Find your local unit here: https://medquest.hawaii.gov/en/contact-us.html
Idaho	Within 28 days from the date the denial notice was mailed.	File an appeal or request a Fair Hearing Form by visiting your local Health and Welfare Office or by calling1 (877) 456-1233 Appeal in writing with your local Department of Health and Welfare office. Use the interactive map to find your nearest location here: https://healthandwelfare.idaho.gov/ContactUs/tabid/127/Default.aspx	Department of Health and Welfare Phone: 1 (877) 456-1233
Illinois	Within 60 days of receiving the notice	Appeal online here: https://abe.illinois.gov/abe/access/appeals OR Call 1 (800) 435-0774 (voice) / 1 (877) 734-7429 (TTY) OR Write a letter or download, print and complete the appeal request form here: https://www.dhs.state.il.us/onenetlibrary/12/documents/forms/il444-0103.pdf When complete, mail, fax or email it to: Illinois Department of Human Services Bureau of Hearings 69 W. Washington, 4th Floor Chicago, IL 60602 Fax: (312) 793-3387 Email: DHS.BAH@Illinois.gov OR Mail or drop off your letter or completed appeals form at your local IDHS office. Find a list of locations here: https://www.dhs.state.il.us/page.aspx?module=12	Illinois Department of Human Services (DHS) Phone: 1 (800) 843-6154
Indiana	Within 60 days of the date listed on the notice	Follow the instructions on the denial notice you received from the Division of Family Resources (DFR). You may request an appeal in writing with the DFR by mail to: FSSA Document Center P.O. Box 1810 Marion, IN 46952 OR File an appeal request in person at your local DFR Office. Find a list of locations here: https://www.in.gov/fssa/dfr/2999.htm	Division of Family Resources Phone: 800-403-0864
Iowa	Within 90 days of the date on your Notice of Decision	Submit an appeal letter explaining why you disagree with the decision by mail, fax or email at: Department of Human Services Appeals Section 1305 E Walnut Street, 5th Floor Des Moines, IA 50319 Fax: (515) 564-4044 Email: appeals@dhs.state.ia.us OR Appeal by phone at:(515) 281-3094 OR Appeal online using the appeal request form here: https://secureapp.dhs.state.ia.us/dhs_titan_public/appeals/appealrequest (English) / https://secureapp.dhs.state.ia.us/dhs_titan_public/appeals/appealrequest/1 (Spanish)	Department of Human Services Phone: (515) 281-3094 appeals@dhs.state.ia.us
Kansas	Within 30 days of the written notice	Mail a written request for a fair hearing to: 1020 South Kansas Avenue Topeka, KS 66612	Office of Administrative Hearings Phone: (785) 296-2433
Kentucky	Within 10 days of the written notice	Contact the Division of Administrative Hearings: Health Services Administrative Hearings branch to inquire about requesting a fair hearing	Health Services Administrative Hearings 105 Sea Hero Road Suite 2 Frankfort, KY 40601 CHFS.HSAHB@ky.gov Phone: (502) 564-6621
Louisiana	Deadline listed on notice of denial	Complete an appeal request form online here: https://www.adminlaw.state.la.us/HH.htm OR Send a written request for appeal by mail or fax to: Division of Administrative LawHealth and Hospitals Section P. O. Box 4189 Baton Rouge, LA 70821-4189 Fax: (225) 219-9823 OR Request an appeal by phone at: (225) 342-5800 or (225) 342-0443	Division of Administrative Law Phone: (225) 342-5800
Maine	Within 30 days of the date of denial	Send a written request for appeal by email to: farmington.dhhs@maine.gov, or email the request to a regional office. Find a list of regional office contact information here: https://www.maine.gov/dhhs/about/contact/offices OR Mail a request for appeal to: Commissioner Dept. of Health and Human Services 11 State House Station Augusta, ME 04333 OR Request an appeal by phone at: 1 (855) 797-4357 OR Visit your local DHHS regional office and tell them you want to request an appeal. Find a list of regional office contact information here: https://www.maine.gov/dhhs/about/contact/offices	MaineCare Helpline1 Phone: (800) 965-7476
Maryland	Within 90 days of receiving the notice	Download, print and complete the Request for Case Review here: https://www.marylandhealthconnection.gov/wp-content/uploads/2019/03/MHC.Appeals.Info_.Form_.pdf When complete, mail or email it to: Maryland Health Connection P.O. Box 857 Lanham, MD 20703-0857 or Office of Administrative Hearings 11101 Gilroy Road Hunt Valley, MD 21031 Email: MHBE.Appeals@maryland.gov OR Appeal by phone at: 1 (855) 642-8572	Maryland Health Connection Phone: 1 (855) 642-8572
Massachusetts	Within 30 days of receiving the notice	Download, print and complete the Fair Hearing Request Form here: https://www.mass.gov/doc/fair-hearing-request-form-2/download (English) / https://www.mass.gov/doc/como-pedir-una-audiencia-imparcial-4/download (Spanish) When complete, mail or fax it to: Office of Medicaid Board of Hearings 100 Hancock Street 6th Floor Quincy, MA 02171 Fax: (617) 887-8797	Board of Hearings Phone: (617) 847-1200
Michigan	Within 60 days of receiving the notice	Download, print and complete the Request for Fair Hearing form here: https://www.michigan.gov/documents/lara/Hearing_request_for_Medicaid_managed_care_Health_Plan_CMH_MI_CHoice_603943_7.pdf When complete, mail or fax it to: Michigan Department of Health and Human Services Michigan Administrative Hearing System P.O. Box 30763 Lansing, MI 48909 Fax: (517) 763-0146	Michigan DHHS Administrative Hearing System Phone: 1 (800) 648-3397
Minnesota	Within 30 days of receiving the notice	Complete an appeal request online using the fillable PDF here: https://edocs.dhs.state.mn.us/lfserver/Public/DHS-0033-ENG OR Download, print and complete the form here: https://edocs.dhs.state.mn.us/lfserver/Public/DHS-0033-ENG-pform When complete, mail or fax it to: Minnesota Department of Human Services Appeals Office P.O. Box 64941 St. Paul, MN 55164-0941 Fax: (651) 431-7523	Department of Human Services: Appeals Division Phone: (651) 431-3600
Mississippi	Within 30 days from the date of mailing on your notice	Request an appeal in writing by writing your own statement or using the General Inquiry Form here: https://medicaid.ms.gov/general-inquiry-form/ Mail, fax or deliver a written request to the regional office listed on your notice of denial	Office of Eligibility Phone: (800) 421-2408
Missouri	Within 60 days of the date of denial	Contact the Division of Legal Services to inquire about requesting a fair hearing	Office of Appeals Phone: (800) 421-2408 Central Missouri Office Phone: (573) 751-0335 P.O. Box 1527 Jefferson City, MO 65102 DLS.JCIMHRG@dss.mo.gov Western Missouri Office Phone: (816) 325-5918 103 N Main, #202 Independence, MO 64050 DLS.KCIMHRG@dss.mo.gov Eastern Missouri Office Phone: (314) 877-20728 501 Lucas and Hunt, Suite 110 St. Louis, MO 63136 DLS.STLIMHRG@dss.mo.gov
Montana	Within 90 days of the mailing date of the notice	Submit a written request for a fair hearing to: Department of Public Health and Human Services Office of Fair Hearings PO Box 2029532 401 Colonial Drive, Third Floor Helena, MT 59620 Fax: (406) 444-3980 hhsofh@mt.gov	Office of Fair Hearings Phone: (406) 444-2470
Nebraska	Within 90 days of receiving the notice	File written or verbal request for appeal with the Heritage Health Plan. Use the online contact form here: https://www.neheritagehealth.com/home/contact OR File an appeal by calling Nebraska Heritage Health	Nebraska Heritage Health Phone: 1 (888) 255-2605
Nevada	Within 90 days of the date of eligibility determination on the eligibility correspondence you receive	Appeal online here: https://www.nevadahealthlink.com/appeals/ OR Download, print and complete the Appeals Request Form here: https://www.medicaid.nv.gov/downloads/provider/FA-90.pdf When complete, mail it to: Nevada Health Link Attn.: Appeals 2310 S. Carson Street, Suite 2 Carson City, NV 89701 OR Appeal by phone at: 1 (800) 547-2927	Nevada HealthLink Call Center Phone: 1 (800) 547-2927
New Hampshire	The Department must receive your appeal request within 30 days of the date written on the notice	Download, print and complete the Appeal Request Form here: https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documents2/appeal-request.pdf When complete, mail it along with your denial notice/decision to: Administrative Appeals UnitMain Building 105 Pleasant Street Concord, NH 03301	Administrative Appeals Unit Phone: 1 (800) 852-3345 ext. 4292
New Jersey	Within 20 days of the date on your Eligibility Determination Notice	The appeals process varies based on the program for which you are denied. Learn about all appeals processes here: https://nj.gov/getcoverednj/findanswers/after/appealform.pdf	Medicaid Fair Hearing Unit Phone: (609) 588-2655 P.O. Box 712 Trenton, NJ 08625-0712
New Mexico	Within 90 days of the date on your Eligibility Determination Notice	Request a fair hearing by phone at: 1 (800) 432-6217 or (505) 827-8164 OR Request a fair hearing by mail at: HSD Hearings Bureau P.O. Box 2348 Santa Fe, NM 87504	New Mexico Medicaid Portal Phone: (800) 283-4465
New York	Within 60 days of receiving the notice	Request a fair hearing using the online request system here: https://otda.ny.gov/hearings/request/ OR Download, print and complete the Fair Hearing Request Form here: https://otda.ny.gov/hearings/forms/request.pdf When complete, mail or fax it to: New York State Office of Temporary and Disability Assistance Office of Administrative Hearings P.O. Box 1930 Albany, NY 12201-1930 Fax: (518) 473-6735 OR Request a hearing by phone at:1 (800) 342-3334 OR If you live in New York City or Albany, you can request a fair hearing in person at the following office locations: Office of Temporary and Disability Assistance Administrative Hearings 14 Boerum Place, 1st Floor Brooklyn, NY 11201 Office of Temporary and Disability Assistance Administrative Hearings 40 North Pearl Street Albany, NY 12243	Office of Administrative Hearings Phone: 1 (800) 342-3334
North Carolina	Within 30 days of receiving the notice	Complete and return the Medicaid Services Recipient Hearing Request Form, which is included in the adverse decision notice. Mail or fax it to: 1711 New Hope Church Road Raleigh NC, 27609 Fax: (984) 236-1871	Office of Administrative Hearings Phone: (984) 236-1850
North Dakota	Within 30 days of the date on the notice of action	Download, print and complete the Request for Hearing form here: https://www.nd.gov/eforms/Doc/sfn00162.pdf When complete, mail, fax or email it to:Appeals Supervisor, Legal Advisory Unit Department of Human Services 600 E Boulevard Ave., Dept. 325 Bismarck, ND 58505-0250 Fax: (701) 328-2173 Email: dhslau@nd.gov	Department of Human Services Phone: (701) 328-2311
Ohio	Department must receive your request within 90 days of the mailing date on notice of action	If you are denied services, you will receive a State Hearing Request form. Complete and return it to: Ohio Department of Job and Family Services Bureau of State Hearings P.O. Box 182825 Columbus, OH 43218-2825 OR Fax a request for a State Hearing to: (614) 728-9574	Ohio Medicaid Consumer Hotline Phone: (800) 324-8680
Oklahoma	Within 30 days of the date the OHCA sends written notice of action	Call (405) 522-7431 to request a form by mail When complete, mail it to: Oklahoma Health Care Authority 4345 N Lincoln Blvd. Oklahoma City, OK 73105	Oklahoma Health Care Authority (OHCA) Phone: (405) 522-7300
Oregon	Within 60 days of receiving the notice	Download, print and complete the Administrative Hearing Request form here: https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/me0443.pdf When complete, mail or return to your local OHA or DHS office. A list of OHA offices can be found here: https://www.oregon.gov/oha/Pages/Contact-Us.aspx A list of DHS offices can be found here: https://www.oregon.gov/dhs/offices/pages/index.aspx	Oregon Health Authority Phone: (800) 375-2863
Pennsylvania	Within 30 days of the mailing date on your letter	Download, print and complete the Fair Hearing Form here: https://services.dpw.state.pa.us/oimpolicymanuals/ma/PA-FS_162_F_7-14.pdf When complete, mail or bring it to your county’s assistance office (CAO). Find a list of locations here: https://www.dhs.pa.gov/Services/Assistance/Pages/CAO-Contact.aspx	Statewide Customer Service Center Phone: (877) 395-8930
Puerto Rico	*	*	*
Rhode Island	Deadline listed on notice	Download, print and complete the Appeal Form here: https://www.dhs.ri.gov/Programs/OHHS-121AppealsInstructionsandFormRev11-29-16.pdf When complete, mail it to: ATTN: Appeals State of Rhode Island P.O. Box 8709 Cranston, RI 02920-8787 OR Submit an appeal by phone at: 1 (855) 840-4774 OR Appeal in person at any DHS office. A list of locations can be found here: https://dhs.ri.gov/about-us/dhs-offices	Department of Human Services Phone: 1 (855) 697-4347
South Carolina	Within 30 days of the mailing date on your letter	File an appeal online using the Eligibility Appeals form here: https://msp.scdhhs.gov/appeals/webform/eligibility-appeals OR File a written appeal by mail, fax or email to: SCDHHS Attn: Eligibility Appeals P.O. Box 100101 Columbia, SC 29202 Fax: (803) 255-8274 or (888) 835-2086 Email: eligappeals@scdhhs.gov	Division of Appeals and Hearings Phone: (803) 898-2600 or (800) 763-9087
South Dakota	Within 30 days of the decision date from South Dakota Medicaid	Request a fair hearing by mailing a letter to: Department of Social Services Office of Administrative Hearings 700 Governors Drive Pierre, SD 57501 OR Submit a request by sending an email to: admhrngs@dss.state.sd.us	Department of Social Services Phone: 1 (800) 597-1603
Tennessee	Within 60 days of the mailing date on your letter	Download, print and complete the appeal form here: https://www.tn.gov/content/dam/tn/tenncare/documents/RequestWilsonHearingForm.pdf When complete, mail or fax it to: TennCare Connect P.O. Box 305240 Nashville,TN 37230-5240 Fax: 1 (855) 315-0669 OR Appeal by phone at: 1 (855) 259-0701	TennCare Connect Phone: 1 (855) 259-0701
Texas	Within 90 days of receiving the notice	Appeal instructions are included in the notice of denial. If you have not received a notice, call 2-1-1 or contact the Appeals Division for assistance.	Appeals Division (512) 231-5701
U.S. Virgin Islands	*	*	*
Utah	Within 30 days from the date the Medicaid Agency sent a denial notice	Download, print and complete the Hearing Request form here: https://jobs.utah.gov/appeals/490.pdf When complete, mail it via US Post Office to: Director’s Office / Administrative Hearings Division of Medicaid and Health Financing PO Box 143105 Salt Lake City, UT 84114-3105 Or, mail it via FedEx or UPS to:Director’s Office / Administrative Hearings Division of Medicaid and Health Financing 288 North 1460 West Salt Lake City, UT 84116-3231 You may also return it by fax (801-536-0143) or email (administrativehearings@utah.gov)	Division of Medicaid and Health Financing Phone: (801) 538-6576
Vermont	Within 60 days of the mailing date on your letter	File a written appeal by mailing a request to: Vermont Health Connect 280 State Dr. Waterbury, VT 05671 Or Email a request to: AHS.DVHAHealthCareAppealsTeam@vermont.gov Or Appeal by phone at: 1 (855) 899-9600 Or If you have a Vermont Health Connect account, file an appeal online here: https://identity.id.vermont.gov/ After you log in, click on “My Requests.”	Vermont Health Connect Phone: (855) 899-9600
Virginia	30 days or the time limit on your written notice	Email a request for appeal to: appeals@dmas.virginia.gov OR Appeal by phone at: (804) 371‐8488 (Voice) / 1 (800) 828-1120 (TTY)	Department of Medical Assistance Services (DMAS) Phone: (804) 371‐8488
Washington	*	If you are denied benefits, you will receive an appeal request form. Complete the form and fax it to: 1 (360) 586-9080 OR Call 1 (855) 923-4633 or 1 (800) 562-3022	Office of Administrative Hearings Phone: 800-583-8271
West Virginia	Within 90 days of the mailing date on your letter	Contact the Board of Review to inquire about Medicaid eligibility appeals	Board of Review State Capitol Complex Building 6, Room 817-B Charleston, WV 25305 Phone: (304) 558-0955 dhhroigbore@wv.gov
Wisconsin	Within 45 days from the date of the notice or within 45 days from the effective date of the decision announced in the notice, whichever is later	Send a written request for appeal to: Department of Administration Division of Hearings and Appeals P.O. Box 7875 Madison, WI 53707 OR Appeal by phone at: 1 (608) 266-3096	Department of Health Services Phone: (800) 362-3002
Wyoming	Within 30 days of being notified	To request an appeal, contact the contact the Customer Service Center	Medicaid Customer Service Center Phone: 1 (855) 294-2127

States have the ability to charge Medicaid recipients for health care services in order to offset the cost of providing medical services. These payments are known as:

Premiums: Monthly fees you pay to your state Medicaid program for enrolling in and maintaining Medicaid health coverage. States can either charge premiums per person or per family.
Copayments: Fees you pay to your health care provider in exchange for receiving health care services. These fees are sometimes called “copays” or “cost-sharing” payments.

Who is exempt from copayments?

According to federal Medicaid regulations, the following individuals do not need to make any copayments for services, regardless of where they live:

American Indian and Alaska Natives who have previously received a service from the Indian Health Service (IHS), tribal health programs or under contract health services referral
Children younger than age 18 (states may choose to extend this exclusion to 19, 20 or 21 years of age)
Individuals living in an institution who contribute almost all of their income toward the cost of care
Individuals receiving hospice care
Women receiving Medicaid through the Breast and Cervical Cancer Treatment Program (exempt only from alternative out of pocket costs)

Which services are exempt from copayments?

In addition to the above groups, certain services are exempt from copayments by federal law. Exempted services include:

Emergency services
Family planning services
Pregnancy-related services
Preventive services for children

States may choose to exclude additional groups of people or services from copayments, but they are required to at least uphold these federal exclusions. For a list of additional copayment exclusions by state, continue reading below.

Who can be charged premiums under Medicaid?

Some states require some certain Medicaid beneficiaries to pay premiums or monthly contributions, otherwise known as enrollment or maintenance fees. They are:

Arkansas
California
Indiana
Iowa
Michigan
Montana

Only the following groups of people can be charged premiums under federal Medicaid regulations:

Pregnant women and infants with household incomes at or above 150 percent of the FPL
Disabled and working individuals with household incomes at or above 150 percent of the FPL
Disabled working individuals who qualify under the Ticket to Work and Work Incentives Improvement Act of 1999
Disabled children who qualify under the Family Opportunity Act
Medically needy individuals

States have the ability to impose premiums on other groups of people whose household income exceeds 150 percent of the FPL.

Medicaid Copayments by State and Territory

Note:

This section does not include federally-exempt groups or federally exempt services.

Alabama

In addition to federal exclusions, the following individuals are exempt from copayments:

Individuals in nursing homes
Individuals younger than 18 years of age
Pregnant women
Native American Indians with an active user letter from the Indian Health Services (IHS)

Service	Copay
Non-preventative physician visit	Between $1.30 – $3.90 per visit
Prescriptions	Between $0.65 – $3.90 per drug
Inpatient hospital visits	$50

Alaska

In addition to federal exclusions, the following individuals are exempt from copayments:

Participants who are eligible for both Medicare and Medicaid if Medicare is the primary payer for the service
Chronic and Acute Medical Assistance (CAMA) recipients

Service	Copay
Non-preventative physician visit	$3 per visit
Visits to a health care provider or clinic	$3 per visit
Outpatient hospital services (except emergencies)	5 percent of the allowed amount
Inpatient hospital visits	$50 per admission, $200 maximum
Prescriptions	$.50 per prescription that costs $50 or less; $3.50 per prescription that costs more than $50

Arizona

In addition to federal exclusions, the following individuals are exempt from copayments:

Children 18 years of age and younger
Individuals who are determined to be Seriously Mentally Ill (SMI) by the Department of Health Services
Individuals enrolled in the Arizona Long Term Care System
Individuals enrolled in the Children’s Rehabilitative Services program
Anyone enrolled in Medicare
Individuals in nursing homes
Individuals receiving hospice care
Women enrolled in the Breast and Cervical Cancer program
Pregnant women
Postpartum women
Native American Indian members who are active or previous users of the Indian Health Service, tribal health programs or urban Indian health programs
Individuals receiving Title IV-E Adoption Subsidy or Foster Care Assistance
Individuals receiving Title IV-B Child Welfare Services
Anyone receiving emergency services or hospitalization

Service	Copay
Office visit	$3.40 – $4
Outpatient therapy	$3
Prescriptions	$2.30
Non-emergency surgery	$3
Non-emergency use of emergency room	$8

Arkansas

Cost-sharing begins at 21% of the federal poverty line. Copay annual limit is $27-$163, based on household FPL.

Service	Copay
Non-preventative physician visit	$4.70 per visit
Prescriptions	$4.70 for generic drugs and preferred brand name drugs; $9.40 for non-preferred brand name drugs

American Samoa

American Samoa residents enrolled in Medicaid do not pay any copayments for services, but hospitals may charge separate fees for service.

Arizona

In addition to federal exclusions, the following individuals are exempt from copayments:

Participants who are eligible for both Medicare and Medicaid
People determined to be Seriously Mentally Ill (SMI)
Individuals eligible for Children’s Rehabilitative Services (CRS)
Individuals enrolled in the Arizona Long-Term Care System (ALTCS)
Individuals receiving child welfare services

Service	Copay
Visits to a health care provider or clinic	$4
Speech, physical or occupational therapy	$3
Outpatient visits	$3
Prescriptions	$2.30 each
Preventive care; Hospitalizations; Pregnancy-related health care and health care for any other medical condition that may complicate the pregnancy, including tobacco cessation treatment for pregnant women, pap smears, colonoscopies, mammograms, immunizations	No copay

California

Most Medi-Cal enrollees do not pay any monthly premiums, copayments or out-of-pocket costs. However, some beneficiaries may need to pay a copayment of $1 each time they receive a prescription medication, dental service or medical service.

They may need to pay $5 when they visit an emergency room (ER) for non-emergencies. Some families enrolled in Medi-Cal may need to pay monthly premiums of $13 per child up to a maximum of $39 per month.

Colorado

In addition to federal exclusions, children younger than 19 years of age and pregnant women are exempt from copayments.

Service	Copay
Vision	$2 per visit
Urgent care center (not an emergency room)	$2 per visit
Preventive services, Home health care, Telemedicine, Dental care, Hospitalizations, Ambulance services, Medical transportation, Anesthesia, Hospice, Breast reconstruction, Private duty nursing, Mental health services, Home health therapy, Immunizations, Outpatient surgery at an ambulatory surgery center	No copay

Commonwealth of Northern Mariana Islands (CNMI)

CNMI residents enrolled in Medicaid do not pay any copayments for services.

Connecticut

Individuals enrolled in the following Medicaid plans do not pay any copayments or out-of-pocket costs for services:

Husky A: Open to children, their families and pregnant women who meet income requirements
Husky C: Open to adults older than 65 years of age as well as blind or disabled individuals between the ages of 18 and 65
Husky D: Open to adults between the ages of 19 and 65 who do not qualify for Medicare, do not qualify for Husky A, do not have dependent children and are not pregnant

Children enrolled in Husky B (CHIP) may need to make copayments and pay premiums for services.

Delaware

In addition to federal exclusions, the following individuals are exempt from copayments:

Children younger than age 21 years of age
Pregnant women up to 1 year after end of pregnancy
Chronic Renal Disease Program (CRDP) members
Long-term care nursing facility group or the acute care hospital group

Copayments range between $0.50-$3.00. Prescription drug copays are based on the cost of the medication, with copay costs varying

District of Columbia

Washington DC residents enrolled in Medicaid do not pay any copayments for services unless they are in a fee-for-service (FFS) plan. FFS enrollees pay a $1 copay for prescriptions and a $2 copay for eyeglasses.

Florida

In addition to federal exclusions, the following individuals are exempt from copayments:

Individuals enrolled in a Medicaid prepaid health plan or health maintenance organization
Children younger than 21 years of age
Pregnant women up to six weeks after end of pregnancy
Individuals requiring emergency services for a condition which, if left untreated, places their health in jeopardy

Service	Copay
Doctor visit	$2 per visit
Hospital outpatient visits	$3 per visit
Prescriptions	2.5 percent of the Medicaid cost of the drug for a maximum of $7.50 per prescription
Non-emergency visit to the emergency room	Maximum $15 per visit

Georgia

In addition to federal exclusions, children younger than 21 years of age and pregnant women are exempt from copayments:

Service	Copay
Prescriptions	$.50 – $3 per prescription
Outpatient Visits	$3 per visit
Inpatient Visits	$12.50 per visit
Ambulatory surgical center	$3 per visit
Federally qualified & rural health centers	$3 per visit
Non-emergency visit to emergency room	$3 per visit
Oral maxillofacial	$.50 – $3 per visit
Emergency room prescriptions	No copay

Guam

Guam residents enrolled in Medicaid do not pay any copayments for services.

Hawaii

Hawaii residents enrolled in Medicaid do not pay any monthly premiums, copayments or out-of-pocket costs for services.

Idaho

In addition to federal exclusions, the following individuals are exempt from copayments:

Children younger than 19 years of age with a family income of 133 percent FPL or lower
Adults 19 years of age or older with a family income of 100 percent FPL or lower
Members admitted to a hospital, nursing facility or intermediate care facility with intellectual disabilities
Children in foster care receiving aid or assistance under Title IV, Part B of the Social Security Act
Members receiving adoption or foster care assistance under Title IV, Part E of the Social Security Act

Service	Copay
Doctor visits (except wellness exams, immunizations, family planning or urgent care provided at an urgent care clinic)	$3.65 per visit
Outpatient hospital services	$3.65 per visit
Speech, physical and occupational therapy	$3.65 per visit
Chiropractic services	$3.65 per visit
Podiatry services	$3.65 per visit
Emergency room visits for non-emergencies	$3.65 per visit
Federally-approved prescriptions	No copay

Illinois

In addition to federal exclusions, the following individuals are exempt from copayments:

Pregnant women up to 60 days after end of pregnancy
Children younger than 19 years of age
Individuals involved in a DCFS case
Individuals who live in a hospital, nursing facility or intermediate care facility for people intellectual disabilities
Individuals who live a supportive living facility or a sheltered care facility

Service	Copay
Doctor visits (including chiropractors, podiatrists, optometrists, and Behavioral Health clinical services)	$3.90
Prescriptions (except for insulin, AIDS drugs, chemotherapy drugs, hemophilia drugs and certain cardiovascular drugs)	$2 for generic, $3.90 for brand-name
Inpatient hospital services	$3.90 per day
Emergency room visits for non-emergencies	$3.90

Indiana

Service	Traditional Medicaid Copay	Hoosier Care Connect Copay
Non-emergency transportation	$.50 – $2	$1 each way
Emergency transportation	No copay	No copay
Prescriptions	$3 per prescription (generic and brand-name)	$3 per prescription (generic and brand-name)
Emergency room visit for non-emergencies	No copay	$3 per visit

Iowa

In addition to federal exclusions, children younger than 21 years of age are exempt from copayments.

Copayments range from $1 to $8 depending on the managed care organization (MCO). Copayments are only charged for non-emergency use of an emergency department.

Some enrollees may be required to pay $3 monthly premiums for dental services. However, these premiums can typically be waived by completing Healthy Behaviors, an oral health assessment and preventive service tool designed to help enrollees maintain optimum oral hygiene. All dental care enrollees are required to complete Healthy Behaviors each year to continue receiving benefits. Learn more about Healthy Behaviors here: https://dhs.iowa.gov/dental-wellness-plan/healthy-behaviors

Kansas

Kansas residents enrolled in Medicaid do not pay any copayments or out-of-pocket costs for services.

Kentucky

In addition to federal exclusions, the following individuals are exempt from copayments:

Foster children
Pregnant women through 60 days after end of pregnancy
Beneficiaries who have reached the 5% cost share limit for the quarter

Service	Copay
Non-preventative doctor visit	$3
Chiropractor	$3
Podiatrist	$3
Optometry	$3
Visit to a rural health clinic, primary care center, or federally qualified health center	$3
Inpatient hospital visit	$50 per admission
Dental	$3
Ambulatory surgical care	$4
Non-emergency visits to an emergency department	$8
Physical, speech and occupational therapy	$3
Durable medical equipment	$4
Laboratory, diagnostic and X-ray services	$3
Prescription drugs	Generic drugs $1, preferred brand name drugs $1, non-preferred brand name drugs $4

Louisiana

In addition to federal exclusions, the following individuals are exempt from copayments:

Children younger than 21 years of age
Long-Term Care recipients

Service	Copay
Prescriptions	$.50 – $3

Maine

In addition to federal exclusions, individuals younger than 21 years of age are exempt from copayments.

Service	Copay
Outpatient hospital services	$3
Inpatient hospital services	$3 per day
Non-emergency use of the emergency room	$3
Home health services	$3
Durable medical equipment	$3
Private-duty nursing and personal care services	$5 per month
Ambulance services	$3
Physical, speech and occupational therapy	$2
Chiropractic and podiatry services	$2
Laboratory and X-ray services	$1
Optical services / Optometric services	$2
Mental health clinic, substance use services and psychiatric services	$2 / $3
Federally qualified and rural health services	$3 per day
Prescription drugs	$3

Maryland

Some Medicaid enrollees may be required to make copayments for prescription medication and pharmacy services up to $3. In addition to federal exclusions, children younger than 21 years of age are exempt from copayments.

Massachusetts

Some Medicaid enrollees may be required to make copayments for certain prescription medication dispensed from pharmacies. In addition to federal exclusions, the following individuals are exempt from copayments:

Children younger than 21 years of age
Pregnant women
Women in their postpartum period (60 days after birth)
Members with incomes at or below 50 percent of the federal poverty level (FPL)
Members receiving benefits from Supplemental Security Income (SSI), Transitional Aid to Families with Dependent Children (TAFDC) or Emergency Aid to the Elderly, Disabled and Children (EAEDC) Program
Members in a long-term care facility
MassHealth Limited members
Certain members who are former foster care individuals and eligible for MassHealth Standard.

Service	Copay
Inpatient hospital visit	$3
Prescriptions	$1 per generic version of the following drugs: antihyperglycemics, antihypertensives, and antihyperlipidemic $3.65 for all other generic and brand-name drugs

Michigan

Some Michigan residents enrolled in Medicaid are required to pay premiums, also called MIHA fees. Fees depend on family size and income. The table below includes premium amounts ranges.

Family size	Premium Amounts per Person
1	$21 – $29 per month
2	$14 – $19 per month
3	$12 – $16 per month

If you have questions about your premiums or would like more information about scenarios not listed, call 1 (800) 642-3195.

Some Medicaid enrollees need to make copayments for services. In addition to federal exclusions, children younger than 21 years of age are exempt from copayments:

Service	Copay (Income at or below 100 percent FPL)
Doctor visits	$2
Outpatient hospital visit	$2
Non-emergency visit to an emergency department	$3
Inpatient hospital visit	$50 per admission
Prescriptions	$1 per preferred drug, $3 per non-preferred drug
Dental	$3
Vision	$2
Chiropractic services	$1
Podiatry services	$2
Hearing aids	$3 per aid
Preventive services; Federally qualified health center services; Rural health clinic services; Mental health specialty services and supports provided/paid by Prepaid Inpatient Health Plan / Community Mental Health Services Program; Mental health services provided through state psychiatric hospitals, the state Developmental Disabilities Center, and the Center for Forensic Psychiatry; Services for certain chronic conditions	No copay

Minnesota

In addition to federal exclusions, the following individuals are exempt from copayments:

Children younger than 21 years of age
Members expected to be admitted for at least 30 days in a hospital, nursing facility, or intensive care unit

Service	Copay
Prescriptions	$1 per generic, $3 per brand-name; maximum $12 per month
Doctor visit (excluding preventive and mental health services)	$28 per visit
Non-emergency visit to an emergency department	$100
Radiology	$45
Prescriptions	$10.00 generic$25.00 brand name$70.00 maximum per monthNo copays for certain mental health drugs
Eyeglasses	$10
Inpatient Hospital	$250.00 per admission

Mississippi

No copays apply.

Missouri

In addition to federal exclusions, the following individuals are exempt from copayments:

Children under 19 years of age
Managed Care enrollees
Members receiving Medicaid due to blindness
Foster care participants

There is no copay required for the following services:

Certain therapy services (physical, chemo, radiation, chronic renal dialysis) not provided as inpatient hospital service
Medically necessary services identified through screening
Mental health services

Some Missouri residents enrolled in Medicaid may be required to make copayments for certain services.

Service	Copay
Doctor visit	$1
Outpatient or emergency room services	$3
Inpatient hospital care	$10
Clinic services	$.50
X-ray and laboratory services	$1
CRNA services, Anesthesiologist assistant services	$.50
Nurse practitioner services	$1
Federally qualified health center or Rural health clinic services	$2
Psychology services	$2
Case management	$1
Non-emergency medical transportation	$2
Dental, optical and podiatry services	$.50 – $3

Montana

Montana residents enrolled in the HELP Medicaid Plan (also known as Medicaid Expansion) are required to pay monthly premiums.

Montana residents enrolled in Medicaid or the HELP Medicaid Plan do not pay any copayments for services.

Nebraska

In addition to federal exclusions, the following individuals are exempt from copayments:

Members in alternative care facilities
Members who are State Disability Program recipients
Members who are Home and Community-Based Medicaid Waiver recipients

Service	Copay
Prescriptions (except birth control)	$2 per generic, $3 per brand-name
Physician visit (except family practice or general practice, pediatricians, internists, nurse practitioners, nurse midwives and physician assistants)	$2 per visit
Outpatient hospital	$3 per visit
Inpatient hospital	$15 per admission
Mental health and substance abuse treatment	$2 per service
Physical and occupational therapy	$1 per visit
Speech therapy	$2 per visit
Chiropractic and podiatry services	$1 per visit
Vision	$2 per visit/exam
Dental	$3 per service
Durable medical equipment	$3 per service
Eyeglasses	$2 per pair
Hearing aids	$3 per aid

Nevada

Nevada residents enrolled in Medicaid do not pay any copayments for services.

New Hampshire

In addition to federal exclusions, members with incomes below 100 percent of the federal poverty level (FPL) are exempt from copayments:

Enrollees with incomes over 100 percent of the FPL have to make copayments for prescriptions. There is a $147 copayment maximum per quarter. Once an enrollee pays $147 in a three-month span, he or she is exempt from copayments for the remainder of the quarter. The quarter schedule is as follows:

Quarter 1: January 1 – March 31
Quarter 2: April 1 -June 30
Quarter 3: July 1 – September 30
Quarter 4: October 1 – December 31

Service	Copay
Generic prescriptions	$1
Brand-name prescriptions	$2

New Jersey

Adult New Jersey residents enrolled in Medicaid do not pay any copayments or out-of-pocket costs for services.

Copayments are required for children age 18 and under if their household income is above 150 percent of the federal poverty level (FPL). If a child qualifies, they must also pay monthly premiums according to the following scale:

0 to 200 percent of the FPL: $0
200 to 250 percent of the FPL: $42.50
250 to 300 percent of the FPL: $85.00
300 to 350 percent of the FPL: $142.50

These amounts are the same by household regardless of how many children in the household participate in the program.

New Mexico

New Mexico residents enrolled in Medicaid do not pay any copayments or out-of-pocket costs for services.

New York

In addition to federal exclusions, the following individuals are exempt from copayments:

Children younger than 21 years of age
Pregnant women up to two months after end of pregnancy
Members living in a nursing home
Members with incomes below 100 percent of the federal poverty level (FPL)
Members residing in an adult care facility licensed by the New York State Department of Health
Members in an Office of Mental Health (OMH) or Office for People with Developmental Disabilities (OPWDD) certified community residence
Members involved in Comprehensive Medical Case Management (CMCM) or Services Coordination Program
Members involved in the Home and Community Based Services (HCBS) or Traumatic Brain Injury (TBI) waiver programs

Service	Copay
Prescriptions	$1 per generic or brand name preferred / $3 per brand-name non-preferred
Over-the-counter drugs	$.50 per drug
Clinic visits	$3 per visit
Inpatient hospital visit	$25
Laboratory services from independent clinical lab or hospital-based / free standing clinic lab	$.50 per test
Non-emergency use of an emergency department	$3 per visit
Medical supplies	$1 per claim
Private practicing physician services (including laboratory and/or x-ray services, home health services, personal care services or long-term home health care services), Psychotropic and tuberculosis drugs	No copay

North Carolina

In addition to federal exclusions, Children younger than 21 years of age are exempt from copayments.

Service	Copay
Prescriptions	$4 per generic and brand-name
Doctor visit	$4 per visit
Dental	$3; only one copay required for services requiring more than one visit
Optometry	$4 per visit
Optical supplies and services	$2 per pair
Outpatient visits	$3 per visit
Psychiatric and psychological care	$3 per visit
Chiropractic care	$4 per visit
Podiatry	$4 per visit
Non-emergency use of an emergency department	$4 per visit

North Dakota

North Dakota residents enrolled in Medicaid do not pay any copayments or out-of-pocket costs for services.

Ohio

In addition to federal exclusions, the following individuals are exempt from copayments:

Children younger than 21 years of age
Pregnant women up to 90 days after end of pregnancy (must still pay copayments for routine eye exams and eyeglass fittings)
Members in a managed care plan that does not charge copayments
Members living in nursing homes

Service	Copay
Prescriptions	$2 per brand-name drugs, $3 per drug requiring prior authorization
Non-emergency use of an emergency department	$3 per visit
Eye exams	$2 per exam
Eyeglasses	$1 per fitting
Dental services	$3 per visit

Oklahoma

In addition to federal exclusions, the following individuals are exempt from copayments:

Children younger than 21 years of age
Members living in nursing homes

Any members who have copays will not have to pay more than 5 percent of their monthly household income on copayments. Once they reach this amount, they will not have to pay any more copayments for the month.

Service	Copay
Prescriptions	$4 per prescription
Doctor visits, including specialists and podiatry	$4 per visit
Outpatient services	$4 per visit
Inpatient services	$10 per day for the first seven days, $5 per day after for a maximum of $75
Home health care	$4 per visit
Laboratory and X-ray services	$4 per visit
Physical, occupational and speech therapy	$4 per visit
Behavioral health and substance abuse treatment services	$3 per visit; $10 per day up to a $75 maximum for inpatient behavioral treatment
Chemotherapy and radiation therapy Clinic services including dialysis	$4 per visit $4 per visit
FQHC and rural health clinic services	$4 per visit
Home health services	$4 per visit
Diabetic supplies	$4 per claim
Immunizations	$4 per date of service
Durable medical equipment	$4 copay when prescribed by a medical provider and requiring prior authorization
Tuberculosis services	$4 per visit

Oregon

Oregon’s Medicaid program does not require copays.

Pennsylvania

In addition to federal exclusions, the following individuals are exempt from copayments:

Residents of long term care facilities
Individuals in the Title IV-B Foster Care and IV-E Foster Care and Adoption Assistance Programs

Service	Copay
Prescriptions	$1 per generic, $3 per brand-name
Inpatient hospital visit	$3 per day; $21 maximum per visit
Non-preventative physician visit	$0.65 or $3.80 depending on if below or above FPL
X-ray or radiation treatment	$1 per test
Outpatient psychotherapy services	$.50 per service
Laboratory services, Home health agency services, Psychiatric partial hospitalization program services, Renal dialysis services, Blood and blood products, Oxygen, Ostomy supplies, Durable medical equipment rental	No copay

For other services requiring copayment, the amount will be the following:

Cost to Medicaid Program	Cost to Medicaid Program
$2 – $10	$.65
$10.01 – $25	$1.30
$25.01- $50	$2.55
$50.01 or more	$3.80

Puerto Rico

In addition to federal exclusions, the following individuals are exempt from copayments:

Children younger than 21 years of age
Pregnant women up to 60 days after end of pregnancy
Individuals with incomes at or below 50 percent FPL
Members living in nursing homes

Service	Copay
Generic prescriptions	$1 each
Brand name prescriptions	$3 each
Doctor visit (primary care or specialist)	$1 per visit
Physical, occupational and respiratory therapy	$1 per procedure
Inpatient visit	$4 per admission
Dental care	$1 per visit
Laboratory and X-ray services	$.50 per procedure
Non-emergency use of an emergency department	$4 – $8 per visit

Rhode Island

Rhode Island residents enrolled in Medicaid do not pay any copayments or out-of-pocket costs for services.

South Carolina

In addition to federal exclusions, the following individuals are exempt from copayments:

Children younger than 19 years of age
Individuals in a nursing facility or ICF-MR
Members of the Health Opportunity Account (HOA) program

Copayments are not required for the following services:

Medical equipment and supplies provided by DHEC
Orthodontic services provided by the DHEC
End stage renal disease (ESRD) services
Infusion center services
Waiver services

Service	Copay
Doctor visits	$3.30 per visit
Anesthesiologist Clinic visits	$3.30 $3.30 per visit
Non-emergency outpatient hospital care	$3.40 per visit
Inpatient hospital care	$25 per admission
Outpatient hospital (non-emergency) Prescriptions	$3.40 per claim $3.40 each
Home health services	$3.30 per visit
Dental care	$3.40 per visit
Optometrist services	$3.30 per visit
Chiropractic and podiatry care	$1.15 per visit
Durable medical equipment and supplies	$3.40 per claim
FQHC and rural health clinic	$3.30 per visit

South Dakota

In addition to federal exclusions, the following individuals are exempt from copayments:

Children younger than 21 years of age
Members living in a long-term care facility or receiving home and community-based services

Service	Copay
Doctor visits	$3 per visit
Chiropractic services	$1 per procedure
Prescriptions	$1 per generic, $3.30 per brand-name
Outpatient hospital care	5 percent of allowable amount; maximum $50
Inpatient hospital care	$50 per admission
Independent mental health practitioners	$3 per procedure
Mental health clinics	5% of allowable reimbursement
Dental care (including dentures)	$3 per procedure / $3 per denture
Optometric Services and Optical Supply	$2 per visit or procedure
Ambulatory surgical care	5 percent of allowable amount; maximum $50
Diabetes education	$3 per unit of service / visit
Nutrition services Optometric services and supply	$2 per day for enteral and $5 per day for parenteral $2 per visit and $2 per procedure
Podiatry care	$2 per visit
Chiropractic care	$1 per procedure
Mental health clinic	5 percent of allowable amount
Independent mental health practitioner	$3 per visit
Durable medical equipment, supplies and prosthetic devices	5 percent of allowable reimbursement amount

Tennessee

Individuals enrolled in Tennessee Medicaid who are below the federal poverty level (FPL) only have copayments for some prescriptions. The following prescriptions do not have copayments:

Prescriptions from hospice care
Birth control
Children on Medicaid whose family income is below 100% of the federal poverty level
Medication prescribed during emergency care
Medicine prescribed for pregnant women

Service	Copay	colspan	colspan
	0-133% FPL	134-199% FPL	200% + FPL
Generic prescriptions		$1.50 each
Brand-name prescriptions		$3 each
Hospital ER (waived if admitted)	$0 per visit	$8.20 per visit	$50 per visit
Primary care provider and community mental health agency services other than preventative care Physician specialists including psychiatrists	$0 per visit $0 per visit	$5 per visit $5 per visit	$15 per visit $20 per visit
Inpatient hospital admission (waived if readmitted within 48 hours for the same episode)	$0 per visit	$5 per visit	$100 per visit

Texas

Texas residents enrolled in Medicaid do not pay any copayments or out-of-pocket costs for services.

U.S. Virgin Islands

Information for Medicaid cost sharing for the U.S. Virgin Islands is not readily available. For more information, contact the Medicaid office at (340) 715-6929.

Utah

In addition to federal exclusions, members in the Medicaid Cancer Program are exempt from copayments.

Service	Copay
Doctor visits, podiatry and outpatient hospital services	$4 per visit; maximum $100 per year
Prescriptions	$4 per prescription; maximum $20 per month
Non-emergency use of an emergency department	$8 per visit
Inpatient hospital visit	$75 per admission
Vision care	$4 per optometrist visit

Vermont

In addition to federal exclusions, individuals living in nursing homes are exempt from copayments.

Service	Copay
Prescriptions	$1 – $3
Dental care	$3 per visit
Outpatient hospital care	$3 per day
Sexual assault-related services	No copayment

Virginia

In addition to federal exclusions, children younger than 21 years of age are exempt from copayments.

Service	Copay
Prescriptions	$1 per generic, $3 per brand-name
Physician office visit	$1 per visit
Other physician visit	$3 per visit
Outpatient hospital visit	$3 per visit
Inpatient hospital visit	$100 per admission
Clinic visit	$1 per visit
Home health care	$3 per visit
Eye exam	$1 per examination
Rehabilitation services	$3 per visit

Washington

Washington residents enrolled in Medicaid do not pay any copayments or out-of-pocket costs for services.

West Virginia

In addition to federal exclusions, the following individuals are exempt from copayments:

Children younger than 21 years of age
Members living in nursing homes

Service	Copay	colspan	colspan
	Up to 50% FPL with max of $8 out of pocket	50.01 – 100% FPL with max of $71 out of pocket	100.01% FPL + with max of $143 out of pocket
Prescriptions	$0 – $3
Doctor visit	$0 per visit	$2 per visit	$4 per visit
Inpatient visit	$0 per visit	$35 per visit	$75 per visit
Non-emergency use of an emergency department		$8 per visit
Outpatient surgical services	$0 per visit	$2 per visit	$4 per visit
Intermediate Care Facility or MR Services		No copayment

Wisconsin

In addition to federal exclusions, the following individuals are exempt from copayments:

Children younger than 19 years of age
Children in foster care or adoption assistance
Pregnant women up to 60 days after end of pregnancy
Members living in nursing homes
Members who enroll by Express Enrollment

Amount of Service	Copay
Up to $10	$.50
$10.01 – $25	$1
$25.01 – $50	$2
More than $50	$3

Wyoming

In addition to federal exclusions, the following individuals are exempt from copayments:

Children younger than 19 years of age
Members living in nursing homes

Service	Copay
Generic prescriptions	$.65 each
Brand-name prescriptions	$3.65 each

Dual Eligibility in Medicare and Medicaid

doctor patient form signing dual eligibility

Some individuals can receive benefits from both Medicaid and Medicare. They are called dual eligible recipients. Dual eligibility affects how medical expenses are billed.

Who qualifies for dual eligibility?

Generally, individuals can be dual eligible if they are over 65 years of age and meet the work requirements for Medicare, while also meeting the income and/or disability requirements for Medicaid.

Individuals with disabilities or late-stage renal failure and low household incomes may also qualify for both Medicare and Medicaid.

How Dual Eligibility Affects Billing

Individuals who qualify for both Medicare and Medicaid will have most benefits covered first by Medicare, then by Medicaid. For instance, if someone receives coverage through Medicare but incurs personal costs or exceeds the Medicare requirements, Medicaid benefits will cover some or all of the expenses.

Some individuals are classified as partial dual, while others are classified as full dual.

Partial-dual eligible individuals are generally eligible for full Medicare benefits, but their incomes will only allow them to receive partial Medicaid benefits with additional costs and copayments. Full-dual eligible individuals will qualify for full benefits from both programs, reducing the amount of cost-sharing they will have to cover.

Your Medicaid Card

When you receive Medicaid benefits, you will be issued a Medicaid card that allows you to obtain access to benefits and Medicaid coverage.

What is a Medicaid card?

A Medicaid card is a card documenting that you are currently eligible for Medicaid benefits. All Medicaid beneficiaries receive a card. Depending on the state, your card may contain any of the following information:

Your name
Your state of residence
Your state’s health department
Your Medicaid ID Number
Your Medicaid card number
Your Medicaid card date of issuance
Your health insurance policy or plan
Your primary care doctor’s name
Your pharmacy of choice

You can only share your Medicaid card number with a Medicaid provider who is providing services to you. Sharing it with anyone else is considered Medicaid fraud. Your benefits will be revoked, and you may be charged a fine or issued a prison sentence of up to 10 years if found guilty of committing Medicaid fraud.

How to Use the Medicaid Card

When you visit a doctor or seek medical services, you can present the Medicaid card in order to receive coverage for your treatment.

It’s a good idea to check if an organization accepts Medicaid before seeking treatment. You can find out where to obtain treatment by contacting the member services phone number on the back of your card.

Replacing a Medicaid Card

If you lose your Medicaid card or it is severely damaged, you should replace it as soon as possible. It can be difficult to obtain benefits without the card and card number.

When to Replace

You should replace a Medicaid card when it is:

Lost
Stolen
Severely damaged and illegible

How to Replace

To replace a lost, stolen or damaged Medicaid card, you should contact your state’s Medicaid agency and request a replacement. Provide any required information, including your name, Social Security Number and residential address to confirm your identity and request the card.

Visit the section titled “Medicaid Contact Information By State and Territory” to find contact information for your state’s Medicaid agency.

Annual Limits

Prior to the passage of the Affordable Care Act (ACA), insurance plans could impose an annual limit on the benefits they would pay out for an individual. Following the ACA’s passage, annual limits on essential health benefits were banned.

Although some plans have been grandfathered into the new law and can continue to impose annual limits, all plans issued from January 1, 2014 onward have no limits.

Plans that begin between September 23, 2010 and September 22, 2011 cannot limit essential benefit coverage to anything less than $750,000 annually.
Plans that begin between September 23, 2011 and September 22, 2012, essential benefits cannot be limited to less than $1.25 million annually.
Plans that begin between September 23, 2012 and January 1, 2014 cannot restrict essential benefits to less than $2 million annually.
All plans that begin after January 1, 2014 can have no annual limits on essential benefits.

Plans can limit non-essential benefits.

Alternative Sources of Subsidized Health Insurance

doctor high fiving child with mother health programs

If you cannot obtain health insurance coverage through Medicaid, you can find other sources of subsidized health insurance to ease the burden of health care costs.

Basic Health Programs

States have the option to implement Basic Health Programs (BHPs) to complement Medicaid programs for individuals who would otherwise not be able to afford a plan through the Marketplace. If you do not currently qualify for Medicaid, you may be eligible for coverage through a BHP.

BHPs provide coverage for citizens and qualified residents whose incomes are between 133 percent and 200 percent of the federal poverty level. They also provide coverage for individuals whose incomes fall below 133 percent of the FPL and cannot obtain Medicaid due to their citizenship status.

All BHPs provide the ten essential benefits as outlined by the Medicaid program and the ACA. As of 2020, Minnesota and New York have implemented BHPs.

Children’s Health Insurance Program (CHIP)

The Children’s Health Insurance Program (CHIP) provides comprehensive free or low-cost healthcare benefits to children whose parents or guardians do not qualify for Medicaid. CHIP is a federal program, and each state/territory has the flexibility to design its own CHIP program within federal guidelines. Therefore, CHIP benefits may differ in each state/territory.

CHIP benefits may include annual check-ups, hospital visits, dental insurance, vision insurance and more. All services are provided through medical providers that participate in the CHIP program. Not all doctors and medical facilities accept CHIP patients.

Learn more about the Children’s Health Insurance Program with our free, in-depth guide here: https://s3.amazonaws.com/onpointglobal.com/chipinfo-org-guides-chipinfo-guide-hr.pdf

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