Your Free Guide to Medicaid

Medicaid_cover

Your Free Guide to Medicaid

You will learn about:
  • Medicaid eligibiity and application methods.
  • Additional benefits you can access in your state or territory.
  • Dual eligibility for Medicare and Medicaid.

262 min – Estimated reading time

Your Free Guide to Medicaid

Your Free Guide to Medicaid

Medicaid_cover

COVID-19 and Medicaid

Due to the impact of COVID-19, states may experience delays in processing applications and administering benefits for Medicaid applicants and recipients. Some offices may be closed or operating remotely, which means applicants and beneficiaries may not be able to seek in-person assistance with processing or claiming benefits.

As a result of the pandemic, the U.S. government has authorized states to modify requirements, expand coverage and remove cost barriers for beneficiaries seeking treatment, particularly treatment for COVID-19 symptoms. 

Specifically, the federal government requires state Medicaid and CHIP programs to provide free COVID testing and vaccines according to the CDC’s guidance on who should be tested. States are allowed to suspend Medicaid premiums during the public health emergency (PHE) if they choose. Even if they do not choose to suspend premiums, however, they are prohibited from disenrolling Medicaid beneficiaries for failure to pay premiums during the PHE, nor can they pursue payment of overdue premiums after it has concluded. Likewise, states may not increase the amount of cost-sharing (co-pays) for Medicaid enrollees during the PHE.

In addition, state Medicaid agencies are required to cover drugs used to treat COVID, including both FDA-approved drugs and drugs that are not yet FDA approved but are authorized under an emergency use authorization for COVID-19. Receiving additional unemployment compensation under the CARES Act does not count toward Medicaid income eligibility requirements. However, if an individual earns more money during COVID in the form of “hazard pay” or “hero pay,” this additional income does count toward the income eligibility requirements.

Your state’s Medicaid website can inform you whether eligibility requirements have been expanded. 

Please refer to the section called “Medicaid Contact Information by State and Territory” to learn how you can contact your state’s Medicaid office for information about changes or services related to COVID-19.  

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

StateMedicaid ProgramDepartment Running ProgramMain Phone NumberOffice Locator
AlabamaAlabama MedicaidDepartment of Public Health1 (334) 242-5000https://medicaid.alabama.gov/content/10.0_Contact/10.1_Medicaid_Contacts/10.1.1_Medicaid_Locations.aspx
AlaskaAlaska MedicaidDepartment of Health and Social Services(800) 770-5650http://dhss.alaska.gov/dpa/Pages/contacts.aspx
American SamoaAmerican Samoa MedicaidState Medicaid Agency1 (684) 699-4777https://medicaid.as.gov/service-facilities/
ArizonaArizona Health Care Cost Containment SystemDepartment of Economic Security1 (855) 432-7587https://www.healthearizonaplus.gov/App/Enrollment_Entity_Search_results.aspx?link=Assistor
ArkansasArkansas MedicaidDepartment of Human Services(501) 682-8292https://humanservices.arkansas.gov/offices/dhs-county-office-map
CaliforniaMedi-CalDepartment of Health Care Services Division(888) ​452-8609https://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx
ColoradoHealth First ColoradoDepartment of Human Services1 (800) 221-3943https://www.colorado.gov/cdhs/contact-your-county
Commonwealth of the Northern Mariana IslandsCNMI MedicaidState Medicaid Agency(670) 664-4890http://medicaid.cnmi.mp/
ConnecticutHusky HealthDepartment of Social Services1 (877) 284-8759https://portal.ct.gov/dss/About-the-Department-of-Social-Services/Contact
DelawareDelaware MedicaidDivision of Medicaid and Medical Assistance(302) 571-4900https://dhss.delaware.gov/dhss/dmma/locations.html
District of ColumbiaDC MedicaidDepartment of Health Care Finance(202) 727-5355https://www.dc-medicaid.com/dcwebportal/nonsecure/medicaidAndMe
FloridaFlorida MedicaidDepartment of Children and Families(850) 300-4323https://www.myflfamilies.com/service-programs/access/map.shtml
GeorgiaGeorgia MedicaidDivision of Family and Children Services(404) 657-5468https://dfcs.georgia.gov/locations
GuamGuam MedicaidPublic Health Social Services(671) 735-7519https://dphss.guam.gov/location-2/
HawaiiMed-QuestDepartment of Human ServicesOahu: (808) 524- 3370 Elsewhere: 1 (800) 316-8005https://medquest.hawaii.gov/en/contact-us.html
IdahoIdaho MedicaidDepartment of Health and Welfare1 (877) 456-1233https://healthandwelfare.idaho.gov/offices 
IllinoisIllinois MedicaidDepartment of Healthcare and Family Services1 (800) 843-6154https://www.dhs.state.il.us/page.aspx?module=12&officetype=&county=
IndianaIndiana MedicaidOffice of Medicaid and Policy Planning1 (800) 457-4584https://secure.in.gov/apps/fssa/providersearch/map
IowaIowa MedicaidDepartment of Human Services1 (800) 338-8366https://dhs.iowa.gov/dhs_office_locator
KansasKanCareDepartment for Children and Families(800) 792-4884http://www.dcf.ks.gov/services/Pages/DCFOfficeLocatorMap.aspx
KentuckyKentucky MedicaidDepartment for Medicaid Services(855) 459-6328https://prd.webapps.chfs.ky.gov/Office_Phone/
LouisianaLouisiana MedicaidDepartment of Health1 (888) 342-6207http://ldh.la.gov/index.cfm/directory/category/158
MaineMaineCareDepartment of Health and Human Services1 (800) 977-6740https://gateway.maine.gov/dhhs-apps/office_finder/
MarylandMaryland MedicaidDepartment of Health and Mental Hygiene(410) 767-5800https://health.maryland.gov/docs/Contact%20Us%20Information.pdf
MassachusettsMassHealthDepartment of Health and Human Services(800) 841-2900https://www.mass.gov/service-details/masshealth-enrollment-centers-mecs
MichiganMichigan MedicaidDepartment of Health and Human Services1 (800) 642-3195https://www.michigan.gov/mdhhs/0,5885,7-339-73970_5461—,00.html
MinnesotaMinnesotaCareDepartment of Human Services(651) 431-2670https://mn.gov/dhs/people-we-serve/adults/health-care/health-care-programs/contact-us/county-tribal-offices.jsp
MississippiMississippi MedicaidDivision of Medicaid(800) 421-2408https://medicaid.ms.gov/about/office-locations/
MissouriMO HealthNetDepartment of Social Services(573) 751-3425https://dss.mo.gov/offices.htm
MontanaMontana MedicaidDepartment of Public Health and Human Services1 (888) 706-1535https://dphhs.mt.gov/hcsd/officeofpublicassistance
NebraskaNebraska MedicaidDepartment of Health and Human Services(402) 471-3121http://dhhs.ne.gov/Pages/Public-Assistance-Offices.aspx
NevadaNevada MedicaidDepartment of Health and Human Services1 (800) 992-0900Northern Office Locations: https://dwss.nv.gov/Contact/Welfare_District_Offices-North
Southern Office Locations: https://dwss.nv.gov/Contact/Welfare_District_Offices-South/
New HampshireNew Hampshire MedicaidDepartment of Health and Human Services(603) 271-4344https://www.dhhs.nh.gov/contactus/districtoffices.htm
New JerseyNew Jersey MedicaidNew Jersey Medicaid1 (800) 356-1561https://www.nj.gov/humanservices/njsnap/home/cbss.shtml
New MexicoCentennial CareHuman Services Department1 (888) 997-2583https://www.hsd.state.nm.us/LookingForAssistance/Field_Offices_1.aspx
New YorkNew York MedicaidDepartment of Health1 (800) 541-2831https://www.health.ny.gov/health_care/medicaid/ldss.htm
North CarolinaNorth Carolina MedicaidDivision of Health Benefits(888) 245-0179https://www.ncdhhs.gov/divisions/social-services/local-dss-directory
North DakotaNorth Dakota MedicaidDepartment of Human ServicesDepartment of Human Serviceshttp://www.nd.gov/dhs/locations/countysocialserv/
OhioOhio MedicaidDepartment of Medicaid1 (800) 324-8680https://jfs.ohio.gov/County/County_Directory.pdf
OklahomaSoonerCareHealth Care AuthorityHealth Care Authorityhttp://1 (855) 840-4774www.okdhs.org/countyoffices/Pages/default.aspx
OregonOregon Health PlanHealth Authority(800) 273-0557http://www.okdhs.org/countyoffices/Pages/default.aspx
PennsylvaniaMedical AssistanceDepartment of Human Services1 (866) 550-4355https://www.dhs.pa.gov/Services/Assistance/Pages/CAO-Contact.aspx
Puerto RicoPuerto Rico MedicaidDepartment of Health and Human Services(787) 765-2929 Ext. 6700http://www2.pr.gov/Directorios/Pages/DirectoriodeMunicipios.aspx
Rhode IslandRI MedicaidExecutive Office of Health and Human Services1 (855) 840-4774http://www.dhs.ri.gov/DHSOffices/index.php
South CarolinaHealthy Connections MedicaidDepartment of Health and Human Services(888) 549-0820https://www.scdhhs.gov/site-page/where-go-help
South DakotaSouth Dakota MedicaidDepartment of Social Services(605) 773-4678https://dss.sd.gov/findyourlocaloffice/
TennesseeTennCareDepartment of Human Services1 (800) 342-3145https://www.tn.gov/humanservices/for-families/supplemental-nutrition-assistance-program-snap/office-locator-family-assistance.html
TexasTexas MedicaidDepartment of Health and Human Services(800) 252-8263https://www.dshs.texas.gov/regions/default.shtm
U.S. Virgin IslandsVirgin Islands MedicaidDepartment of Human Services(340) 715-6929https://www.vimmisuat.com/PageViewer.aspx?auth=0&Url=%2FTPA%2FPages%2FContactInfo.aspx
UtahUtah MedicaidDepartment of HealthSalt Lake City: (801) 538-6155
Other Locations: 1 (800) 662-9651
https://jobs.utah.gov/jsp/officesearch/#/map
VermontVermont MedicaidDepartment of Vermont Health Access(802) 879-5900https://www.healthvermont.gov/local
VirginiaCover VirginiaDepartment of Social ServicesDepartment of Social Serviceshttps://coverva.org/findhelp/
WashingtonApple HealthHealth Care Authority1 (800) 562-3022https://www.hca.wa.gov/assets/free-or-low-cost/community_based_staff_contact.pdf
West VirginiaWest Virginia MedicaidWest Virginia Medicaid1 (877) 716-1212https://dhhr.wv.gov/pages/field-offices.aspx
WisconsinBadgerCareDepartment of Health Services(608) 266-1865https://www.dhs.wisconsin.gov/forwardhealth/imagency/index.htm
WyomingWyoming MedicaidWyoming Medicaid(307) 777-7531https://wymedicaid.portal.conduent.com/Webportal/DFS_Offices_by_County.pdf

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.”

Cost Sharing

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 state-approved
  • Medical transportation services
  • Tobacco cessation counseling services for pregnant women

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

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

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
  • 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 
  • 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/docs/default-source/consumers/choosing-a-plan/2020-english-vab_final.pdf?sfvrsn=bdf54f1b_8

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
  • Dental services 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
  • Nurse First advice line
  • 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 for individuals 20 years of age or younger
  • 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
  • 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 for people under 21 years of age
  • Chiropractic services for people under 21 years of age who are getting long-term care
  • Dental services for people under 21 years of age who are getting long-term care
  • 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 under age 21 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 2022, 39 states (including the District of Columbia) have adopted the Medicaid expansion and 12 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 Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia

States That Have Not Expanded Medicaid Coverage

  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Montana
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Dakota
  • Ohio
  • Oregon
  • Pennsylvania
  • Rhode Island
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia

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

  • Alabama
  • Florida
  • Georgia
  • Kansas
  • Mississippi
  • North Carolina
  • South Carolina
  • South Dakota
  • 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 2022 FPL chart is as follows:

Family SizeAnnual Income Limit
1 person$13,590
2 people$18,310
3 people$23,030
4 people$27,750
5 people$32,470
6 people$37,790
7 people$41,910
8 people$46,630

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. 

Alabama 

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

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.

Income requirements:

Pregnant Women200 percent of FPL
Children Under 19 – WITH Insurance177 percent of FPL
Children Under 19 – WITHOUT Insurance203 percent of FPL
Expansion Group 133 percent of FPL
QMB100 percent of FPL
SLMB Base120 percent of FPL
SLMB Plus135 percent of FPL
QDWI200 percent of FPL
Working Disabled250 percent of FPL

The expansion group refers to all low-income adults who are not children, members of households with children or pregnant women. 

SLMB Plus refers to a Medicaid program that covers Medicare Part B premiums for low-income individuals not enrolled in a full Medicaid program. 

QDWI refers to Qualified Disabled Working Individuals. It covers Medicare Part A premiums for disabled individuals under 65 years of age who work and otherwise don’t qualify for Medicaid.

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.

Other eligibility requirements:

GroupIncome LimitAsset LimitOther RequirementsMedical Benefits
Children under age 1147 percent of FPLNoneNoneMedicaid services
Children between 1 and 5 years of age141 percent of FPLNoneNoneMedicaid services
Children between 6 and 19 years of age133 percent of FPLNoneNoneMedicaid services
Parent and caretaker relatives106 percent of FPLNoneNoneMedicaid services
Adults133 percent of FPLNone-Between 19 and 65 years of age-Not eligible for Medicare-Not available to state employees, their children or spouses-$10-$70 monthly premium covers all childrenMedicaid services
Pregnant women156 percent of FPLNoneNoneMedicaid services
Breast & Cervical Cancer Treatment ProgramNoneNone-Under age 65  -Screened and diagnosed with breast cancer, cervical cancer, or a precancerous cervical lesion by the Well Woman Health check Program  -Ineligible for any other Medicaid coverage Medicaid services
Long-Term Care300 percent of Federal Benefit Rate$2,000 individual-Requires nursing home level of care or equivalent  -May be required to pay a share of cost  -Estate recovery program for the cost of services received after age 55 Medicaid services, nursing facility, home and community-based services and hospice
Social Security Income – CASH100 percent of Federal Benefit Rate$2,000 individual$3,000 coupleMedicaid services
Social Security Income – Medical Assistance Only100 percent of FPLNone-Age 65 or older, determined to be blind or have a disabilityMedicaid services
Freedom to Work250 percent of FPLNone-Between 19 and 64 years of age-Must be working and either determined to be blind or have a disability-Premium between $0 and $35 monthlyAND-Need for Nursing home level of care or equivalent is required for Long-Term Care (Nursing Facility, Home & Community Based Services, or Hospice)Medicaid services, nursing facility, home and community-based services, and hospice
QMB – Low-Income Medicare Beneficiaries100 percent of FPLNone-Entitled to Medicare Part APayment of Part A and B premiums, coinsurance and deductibles
SLMB – Specified Low-Income Medicare Beneficiaries120 percent of FPLNone-Entitled to Medicare Part APayment of Part B premium
QI-1 Qualifying Individual135 percent of FPLNone-Entitled to Medicare Part A-Not receiving Medicaid benefitsPayment of Part B premium

Check to see if you meet the income requirements for Arizona Medicaid here: https://www.benefits.gov/benefit/1000

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 household income level below 138 percent of the FPL.

Check if you meet Arkansas’s Medicaid income requirements here: https://www.benefits.gov/benefit/1089

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):

One personTwo peopleThree peopleFour peopleFive peopleSix people
Parents and caregivers$21,744$29,269$36,848$44,400$51,952$59,504 
Children$27,316$36,803$46,290$55,778$65,265$74,752 
Pregnant women*Unborn always count as one person$48,155 $60,569$72,983 $85,396 $97,810
Adults 18-64 without children$18,754 $25,268 $31,781 $38,295$44,809 $51,322

Check to see if you meet Connecticut Medicaid eligibility requirements here: https://www.connect.ct.gov/access/jsp/access/Home.jsp

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

You must also meet the income and resource requirements:

GroupIncome LimitResource Limit
Children (0-18)300 percent of FPLNone
Youth (19-20)200 percent of FPLNone
Pregnant women300 percent of FPLNone
Aged, blind or disabled100 percent of FPL1 person – $4,0002 people – $6,000
Adult200 percent of FPLNone

Check to see if you’re eligible for Medicaid in the District of Columbia here: https://www.benefits.gov/benefit/1624 

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.
GroupIncome LimitResource Limit
SSI Recipients1 person – $841 per month
2 people – $1,261 per month
1 person – $2,000
2 people – $3,000
Nursing Home Resident$2,523 per month1 person – $2,000
2 people – $3,000
Community Care$2,523 per month1 person – $2,000
2 people – $3,000
Qualified Medicare Beneficiaries1 person – $1,153 per month
2 people – $1,546 per month
1 person – $8,400
2 people – $12,600
Hospice Patients$2,523 per month1 person – $2,000
2 people – $3,000
Parent/Caretaker With Children Under 191 person – $310 per month
2 people – $457 per month
3 people – $551 per month
4 people – $653 per month
Additional person – $50 per month
None
Pregnant Women220 percent of FPLNone
Children Age 0-1205 percent of FPLNone
Children Age 1-5149 percent of FPLNone
Children Age 6-19133 percent of FPLNone
Medically Needy Pregnant Women And Children1 person – $208 per month
2 people – $317 per month
3 people – $375 per month
4 people – $442 per month
1 person – $2,000
2 people – $4,000 + $100 for each additional person
Individuals who are 65 or older, blind or disabled$317 per month$2,000
Couples who are 65 or older, blind or disabled$375 per month$4,000

Check to see if you meet Georgia Medicaid income eligibility requirements here: https://www.benefits.gov/benefit/1626

Guam

  1. Apply using the Application for Public Benefits.
  2. Download the form here: http://dphss.guam.gov/wp-content/uploads/2019/05/ApplicationforPublicBenefits.pdf
  3. 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 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://www.benefits.gov/benefit/1627

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.

The following tables depict monthly income limits for people who qualify for Medicaid in Indiana:

GroupIncome LimitResource Limit
Pregnant Women2 people – $3,250
3 people – $4,088
4 people – $4,926
5 people – $5,764
None
Children1 person – $2,889
2 people – $3,891
3 people – $4,894
4 people – $5,898
5 people – $6,900
None
Adults1 person – $1,564
2 people – $2,106
3 people – $2,649
4 people – $3,192
5 people – $3,734
None
Aged, Blind And Disabled1 person – $1,133
2 people – $1,526
3 people – $1,920
4 people – $2,313
5 people – $2,706
1 person – $2,000
2 people – $3,000

Check to see if you qualify for Indiana Medicaid here: https://fssabenefits.in.gov/bp/#/screening/screen-for-services

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://dhsservices.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 are eligible for Medicaid in Kansas here: https://cssp.kees.ks.gov/apspssp/ 

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 qualify for Medicaid in Kentucky here: https://www.benefits.gov/benefit/1214

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 are eligible for Medicaid in Louisiana here: https://www.benefits.gov/benefit/1270

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

Below are the Maine income requirements for Medicaid.

CategoryIncome RequirementResource Requirement
Child, 0-1 years old196 percent of FPLNone
Child, 1-18 years old162 percent of FPLNone
Child, 19-20 years old161 percent of FPLNone
Parent/Caretaker105 percent of FPLNone
Pregnant Woman214 percent of FPLNone
Low-Income Expansion Adult138 percent of FPLNone
Aged, Blind or Disabled Adult100 percent of FPL$2,000 per individual or $3,000 per couple
Working Disabled Adult250 percent of FPLUnearned income must be below 100 percent of FPL. $8,000 per individual, $12,000 per couple.

Check to see if you qualify for Medicaid in Maine here: https://www1.maine.gov/benefits/prescreen/getting_started/new_prescreen.html

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

Below is a table that goes over income and resource requirements for Medicaid eligibility in Maryland.

CategoryIncome LimitAsset Limit
Children1 person – $2,391
2 people – $3,220
3 people – $4,051
4 people – $4,880
5 people – $5,710
6 people – $6,541
None
Adults1 person – $1,564
2 people – $2,106
3 people – $2,650
4 people – $3,192
5 people – $3,734
6 people – $4,278
None
Pregnant Women2 people – $4,029
3 people – $5,069
4 people – $6,106
5 people – $7,144
6 people – $8,184
None
Disabled Working Individuals300 percent of FPL1 person – $2,500
2 people – $3,000 +$100 for each additional person.
Medically Needy Individuals24 percent of FPL1 person – $2,500
2 people – $3,000 +$100 for each additional person.
Refugees200 percent of FPL1 person – $2,500
2 people – $3,000 +$100 for each additional person.

Check to see if you qualify for Medicaid in Maryland here: https://www.marylandhealthconnection.gov/shop-and-compare/medicaid-basics-and-benefits/

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

You must also meet the following income requirements in place to qualify for Medicaid. 

Household SizeAnnual Income Limit
1$18,075
2$24,353
3$30,630
4$36,908
5$43,186
6$49,463
7$55,741
8$62,018

Check to see if you are eligible for Medicaid in Massachusetts here:     https://www.mahix.org/individual/                                                                                                                                                                                                                                                                              

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 eligible for Medicaid in Michigan here: https://www.benefits.gov/benefit/1221#Eligibility_Checker

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.

Here are the income limits for Medicaid in Minnesota:

GroupIncome LimitAsset Limit
Parents and caretakers133 percent of FPLNone
Adults133 percent of FPLNone
Children 19-20 years old133 percent of FPLNone
Children 2-18 years old278 percent of FPLNone
Children 0-2 years old283 percent of FPLNone
Elderly, Blind, Disabled (No spend-down)100 percent of FPL1 person – $3,0002 people – $6,000 +$200 per additional person
Elderly, Blind, Disabled (Spenddown)81 percent of FPL1 person – $3,0002 people – $6,000 +$200 per additional person
Qualified Medicare Beneficiaries100 percent of FPL1 person – $10,0002 people – $18,000
Service Limited Medicare Beneficiaries120 percent of FPL1 person – $10,0002 people – $18,000
Qualifying Individuals135 percent of FPL1 person – $10,0002 people – $18,000
Qualified Working Disabled Individuals200 percent of FPL1 person – $4,0002 people – $6,000

Check to see if you are eligible for Medicaid in Minnesota here: https://www.benefits.gov/benefit/1286

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

In addition, you must meet the income requirements. They are as follows:

GroupIncome LimitAsset/Resource Limit
Children 0-1194 percent of FPLNone
Children 1-6143 percent of FPLNone
Children 6-19133 percent of FPLNone
Parents and caretakers26 percent of FPLNone
Pregnant women194 percent of FPLNone
Working while disabled250 percent of FPL1 person – $24,000 2 people – $26,000
SSI RecipientsNone1 person – $2,0002 people – $3,000
Aged, Blind and Disabled221 percent of FPL$4,000

Check to see if you are eligible for Medicare in Mississippi here: https://www.access.ms.gov/Prescreen/Start

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

You must also meet the following income and asset requirements: 

GroupIncome LimitAsset Limit
Children 0-1196 percent of FPLNone
Children 1-18148 percent of FPLNone
Pregnant women196 percent of FPLNone
Uninsured women201 percent of FPLNone
QMB100 percent of FPL1 person – $7,860
2 people – $11,800
SLMB135 percent of FPL1 person – $7,860
2 people – $11,800
Aged and disabled individuals85 percent of the FPL1 person – $2,000
2 people – $4,000
Blind individuals100 percent of FPL1 person – $2,000
2 people – $4,000
Low-Income Families17 percent of FPLNone

Check to see if you are eligible for Medicaid in Missouri here: https://www.benefits.gov/benefit/1632 

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 are eligible for Medicaid in Montana here: https://apply.mt.gov/access/accessController?id=0.9020903123560029 

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.

In addition, you must also meet the income requirements listed below: 

GroupIncome Limit
Individuals 19-21 who entered a subsidized guardianship or adoption agreement after 16 years of age23 percent of FPL
Individuals 19-21 who are currently or formerly institutionalized for a mental disease51 percent of FPL
Parents and caretakers58 percent of FPL
Pregnant women194 percent of FPL
Transitional medical coverage for people who lose Medicaid eligibility185 percent of FPL
Children 0-1162 percent of FPL
Children 1-5145 percent of FPL
Children 6-18133 percent of FPL
Workers With Disabilities200 percent of FPL
ABD/OMB/MSP/QMB100 percent of FPL
SLMB120 percent of FPL
QI135 percent of FPL

Check to see if you are eligible for Medicaid in Nebraska here: https://www.benefits.gov/benefit/1302 

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 are eligible for Medicaid in Nevada here: https://accessnevada.dwss.nv.gov/public/am-i-eligible/start 

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

In addition, you must also meet the income and resource requirements: 

GroupIncome LimitsResource Limits
Children196 percent of FPLNone
Pregnant women196 percent of FPLNone
Parents and caretakers1 person – $6702 people – $8163 people – $9654 people – $1,108None
Low-income adults133 percent of FPLNone
Family Planning196 percent of FPLNone
QMB100 percent of FPL1 person – $7,8602 people – $11,800
SLMB135 percent of FPL1 person – $7,8602 people – $11,800
MEAD – Medicaid For Employed Adults With Disabilities450 percent of FPL1 person – $29,9272 people – $44,888
QDWI – Qualified Disabled And Working Individuals200 percent of FPLNone
Nursing Facility CareGross income $2,359Net income $591$2,500

Check to see if you are eligible for Medicaid in New Hampshire here: https://nheasy.nh.gov/#/screening 

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

You must also meet the income and resource requirements: 

GroupIncome LimitResource Limit
Children355 percent of FPL
Parents or caretakers138 percent of FPL
Pregnant women205 percent of FPL
SSI-eligible individuals1 person – $814.252 people – $1,200.361 person – $2,0002 people – $3,000
Low-income disabled individuals100 percent of FPL1 person – $4,0002 people – $6,000
Working DisabledGross: $5,383 per month for 1; $7,249 per month for 2Unearned: $1,064 per month for 1; $1,437 per month for 21 person – $20,0002 people – $30,000
Long-Term Services1 person – $2,3491 person – $2,000

Check to see if you are eligible for Medicaid in New Jersey here: https://www.njhelps.org/NJHelpsHomePage 

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

You must also meet the income and resource requirements: 

GroupIncome LimitResource Limit
Adults133 percent of FPLNone
Pregnant women (Full Medicaid)Fixed Standard*None
Pregnant Women (Pregnancy care only)250 percent of FPLNone
Children 0-5240 percent of FPLNone
Children 6-18190 percent of FPLNone
Parent or caretakerFixed Standard*None
SSI Recipients1 person – $783 per month2 people – $1,175 per month1 person – $2,0002 people – $3,000
Working Disabled250 percent of FPLNone
QMB100 percent of FPLNone
QI135 percent of FPLNone
SLIMB120 percent of FPLNone

*The Fixed Standard Monthly Income Limits are as follows:

1 person$451
2 people$608
3 people$765
4 people$923
5 people$1,080
6 people$1,238
7 people$1,395
8 people$1,553
Each additional person+$158

Check to see if you are eligible for Medicaid in New Mexico here: https://www.yes.state.nm.us/yesnm/home/index 

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. 

For aged, disabled and blind individuals, annual incomes and resource limits should fall below the following limits: 

No. of household membersIncome LimitResource Limit
1 person$11,200$15,750
2 people$16,400$23,100
3 people$18,860*
4 people$21,320*
5 people$23,780*
6 people$26,240*
7 people$28,700*
8 people$31,160*
9 people$33,620*
10 people$36,080*
Each additional person$2,460*

Check to see if you are eligible for Medicaid in New York here: https://www.benefits.gov/benefit/1637 

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

You must also meet the income and resource requirements.

GroupIncome LImitsResource Limits
Aged, Blind or Disabled100 percent of FPL1 person – $2,0002 people – $3,000
Health Care For Working Disabled200 percent of FPL$25,728
QMB100 percent of FPL1 person – $7,8602 people – $11,800
SLIMB120 percent of FPL1 person – $7,8602 people – $11,800
QI 135 percent of FPL1 person – $7,8602 people – $11,800
Working Disabled (Medicare recipients)200 percent of FPL1 person – $4,0002 people – $6,000
Parents and caretakers1 person  – Monthly Income Limit: $434
2 people – Monthly Income Limit: $569 
3 people – Monthly Income Limit: $667 
4 people – Monthly Income Limit: $744 
5 people – Monthly Income Limit: $824
$3,000
Pregnant women196 percent of FPLNone
Children 0-6210 percent of FPLNone
Children 6-18133 percent of FPLNone
Foster Care ChildrenNone$3,000
Family Planning195 percent of FPLNone

Check to see if you are eligible for Medicaid in North Carolina here: https://www.benefits.gov/benefit/1390 

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

You should also meet the income and resource requirements.

GroupIncome LimitResource limit
Entire Family1 person – Monthly Income Limit:  $517
2 people – Monthly Income Limit: $694
3 people – Monthly Income Limit: $871
4 people – Monthly Income Limit: $1,048
5 people – Monthly Income Limit: $1,226
None
Aged, Blind, Disabled1 person – Monthly Income Limit:  $940
2 people – Monthly Income Limit: $1,267
3 people – Monthly Income Limit: $1,593
4 people – Monthly Income Limit: $1,920
5 people – Monthly Income Limit: $2,246
1 person – $3,0002 people – $6,000
Low-Income Adult138 percent of FPLNone
Children 0-61 person – Monthly Income Limit: $1,722
2 people – Monthly Income Limit: $2,320
3 people – Monthly Income Limit: $2,918
4 people – Monthly Income Limit: $3,515
5 people – Monthly Income Limit: $4,113
None
Children 6-191 person – Monthly Income Limit: $1,563
2 people – Monthly Income Limit: $2,106
3 people – Monthly Income Limit: $2,649
4 people – Monthly Income Limit: $3,192
5 people – Monthly Income Limit: $3,735
None
Pregnant Women1 person – Monthly Income Limit:$1,835
2 people – Monthly Income Limit: $2,472
3 people – Monthly Income Limit: $3,110
4 people – Monthly Income Limit: $3,747
5 people – Monthly Income Limit: $4,384
None

Check to see if you are eligible for Medicaid in North Dakota here: https://www.nd.gov/dhs/services/medicalserv/medicaid/eligible.html 

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

You must also meet the following income requirements according to your household size:

Family SizeMonthly Income Limit
1$1,699
2$2,289
3$2,879
4$3,469
5$4,059
6$4,649
7$5,239
8$5,829
9$6,419
10$7,009

Check to see if you are eligible for Medicaid in Ohio: https://benefits.ohio.gov/eligibility-check.html?lang= 

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

You must also meet the income and resource requirements to receive benefits.

GroupIncome Limit
Children210 percent of FPL
Pregnant Women133 percent of FPL
Caretakers And Parents44 percent of FPL
Insure Oklahoma – Employee Sponsored Insurance227 percent of FPL
Insure Oklahoma – Individual Plan105 percent of FPL

Check to see if you are eligible for Medicaid in Oklahoma 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 are eligible for Medicaid in Oregon here: https://www.benefits.gov/benefit/1334 

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. The resource limits are listed below:

GroupResource Limits
General Assistance Recipients1 person – $2502 people – $1,000
SSI Recipients1 person – $2,0002 people – $3,000
Medically Needy1 person – $2,4002 people – $3,200Each additional person – $300
QMB/SLMB/QI1 person – $7,8602 people – $11,800

Check to see if you are eligible 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 MembersMonthly 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:

GroupIncome Limit
Parents and caretakers133 percent of FPL
Pregnant women253 percent of FPL
Children261 percent of FPL
Adults133 percent of FPL

Check to see if you are eligible for Medicaid in Rhode Island here: https://healthyrhode.ri.gov/access/am-i-eligible?PAGE_ACTION=LoadWelcome&language=EN 

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

You must also meet the following income and resource requirements to receive benefits.

GroupIncome LimitResource Limit
Aged, Blind, Disabled100 percent of FPL1 person – $ 7,860. 2 people –  $11,800
Women With Breast And Cervical Cancer196 percent of FPLNone
Disabled Children300 percent of FBRNone
Family Planning194 percent of FPLNone
Individuals In Nursing Care Or Community Care$2,349Spousal allocation – $3,216.00
Medically Indigent Assistance200 percent of FPL$35,000 limit on equity valueA family farm of 50 acres or less on which the applicant or his family has lived for at least 25 years is excluded from resources.Equity interest in real property and taxable personal property (such as motor vehicles) cannot exceed a combined total value of $6,000Assets in cash cannot exceed $500
Parent Or Caretaker62 percent of FPLNone
Children208 percent of FPLNone
Pregnant Women And Infants194 percent of FPLNone
QMB100 percent of FPL1 person – $ 7,860. 2 people – $ 11,800
SLMB120 percent of FPLNone
QI135 percent of FPLNone
Working Disabled250 percent of FPLNone

Check to see if you are eligible for Medicaid in South Carolina here: https://www.scdhhs.gov/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

In addition, you must also meet the income and asset limit requirements: 

Low Income Families

Family SizeMonthly Income Limit
1$620
2$779
3$882
4$1,001
5$1,112
6$1,225
7$1,335
8$1,443

Pregnant Women

  • Income equal to 138 percent of FPL or lower

Women With Breast And Cervical Cancer: 

  • Individual income below or equal to $25,520 a year

Workers With Disabilities:

  • Less than $814 of unearned income per month
  • Less than $8,000 in resources

Residents With Developmental Disabilities, Individuals In Assisted Living Facilities, Disabled Children, Elderly Individuals Who Would Require Nursing Home Care

  • Individual’s monthly income must be less than 300 percent of the SSI Standard Benefit Amount
  • Resources must be less than $2,000

Quadriplegics Who Would Require Nursing Home Care

  • Monthly income below $2,523 a month
  • Less than $2,000 in resources

Check to see if you are eligible for Medicaid in South Dakota here: https://apps.sd.gov/ss36snap/web/Portal/PreScreeningDetails.aspx

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

You must also meet the income guidelines:

GroupIncome LimitResource lImit
Children 0-1 years old195 percent of FPLNone
Children 1-6 years old142 percent of FPLNone
Children 6-19 years old133 percent of FPLNone
Pregnant women195 percent of FPLNone
Parents and caretakers1 person – Monthly Income Limit: $1,018
2 people – Monthly Income Limit: $1,329
3 people – Monthly Income Limit: $1,611
4 people – Monthly Income Limit: $1,867
None
Medically needy1 person – Monthly Income Limit: $241
2 people – Monthly Income Limit: $258
3 people – Monthly Income Limit:  $317
4 people – Monthly Income Limit: $325
1 person – $2,000
2 people – $3,000
Individuals who get SSI1 person – Monthly Income Limit: $841
2 people – Monthly Income Limit: $1,261 
1 person – $2,000
2 people – $3,000
Institutionalized IndividualsMonthly income limit: $2,523$2,000
Women with breast or cervical cancer250 percent of FPLNone

Check to see if you are eligible for Medicaid in Tennessee here: https://www.tn.gov/tenncare/members-applicants/eligibility/categories.html 

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: 

GroupIncome LimitAsset Limit
Children133 percent of FPLNone
Transitioning foster care youth, 18-20413 percent of FPLNone
Pregnant women198 percent of FPLNone
Working with disabilities230 percent of FPL$2,000
Children with disabilities147 percent of FPLNone

Check to see if you are eligible for Medicaid in Texas here: https://yourtexasbenefits.com/Screener/WhatToExpect

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

  1. Apply using the Medicaid Application. Download the form here: http://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 are eligible for Medicaid in Utah here: https://medicaid.utah.gov/eligibility/

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: 

GroupIncome Limit
Children312 percent of FPL
Pregnant women208 percent of FPL
Adult133 percent of FPL
Working while disabled250 percent of FPL
Aged, disabled400 percent of FPL

Check to see if you are eligible for Medicaid in Vermont here: https://www.benefits.gov/benefit/1642

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:

GroupIncome Limit
Children148 percent of FPL
Pregnant women148 percent of FPL
Adults138 percent of FPL
Aged, blind and disabled individuals80 percent of FPL
Working disabled80 percent of FPL

Check to see if you are eligible for Medicaid in Virginia here: https://coverva.org/screening/

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:

GroupIncome Limit
Adults 19-64 years old138 percent of FPL
Parents or caretakers48 percent of FPL
Pregnant women198 percent of FPL
Children215 percent of FPL
Aged, Blind and Disabled74 percent of FPL

Check to see if you are eligible for Medicaid in Washington here: https://www.benefits.gov/benefit/1644

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:

GroupIncome Limit
Children 0-1163 percent of FPL
Children 1-6146 percent of FPL
Children 6-19138 percent of FPL
Pregnant women190 percent of FPL
Adults 19-65138 percent of FPL

Check to see if you are eligible for Medicaid in West Virginia 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 are eligible for Medicaid in Wisconsin here: https://access.wisconsin.gov/access/accessController?id=0.33236792790396974

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:

GroupIncomeAssets
Children 0-5154 percent of FPLNone
Children 6-18133 percent of FPLNone
Pregnant women154 percent of FPLNone
Aged, Blind or Disabled – Inpatient Care300 percent of FPL1 person – $2,0002 people – $3,000
Qualified Medicare Beneficiary135 percent of FPL1 person – $7,8602 people – $11,800
Specified Low-Income Medicare Beneficiary135 percent of FPL1 person – $7,8602 people – $11,800
Parent or caretaker50 percent of FPLNone
Women with breast or cervical cancer250 percent of FPLNone
Working with disabilities300 percent of FPLNone

Check to see if you are eligible for Medicaid in Wyoming here: https://www.benefits.gov/benefit/1647

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
  • 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/documents/9.0_Resources/9.4_Forms_Library/9.4.1_Applicant-Recipient_Forms/9.4.1_Application_Joint_10-1-13.pdf

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%2050C%20(06-3860)%20rev%2009.20.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: http://dhss.alaska.gov/dpa/Pages/contacts.aspx 

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

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

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/offices/dhs-county-office-map 

Apply using a Household Health Coverage Application. Download and print the form here: https://humanservices.arkansas.gov/images/uploads/dco/DCO-0152.pdf_.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://www.colorado.gov/pacific/sites/default/files/Health%20First%20Colorado%20and%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

  1. Apply using the Application for Medical Assistance for the Needy. You can pick one up at the Medicaid office or download it here: http://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 

  1. Apply online through Access Health CT: https://www.accesshealthct.com/AHCT/cthix/#/home
  2. Apply by phone at 1 (855) 805-4325.
  3. 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
  4. 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 

  1. Apply online through the ASSIST portal: https://signup.assistselfservice.dhss.delaware.gov/?destination=0
  2. 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

  1. Apply online through DC Health Link: https://www.dchealthlink.com
  2. 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.
  3. Apply by phone at 1 (855) 532-5465.
  4. Apply in person at any ESA service center. Find a list of locations here: https://dhcf.dc.gov/service/how-apply-medical-coverage

Florida 

  1. Apply online through the ACCESS Florida portal:  https://dcf-access.dcf.state.fl.us/access/scrflstartappl.do?performAction=init&showMensaje=true
  2. Apply using the Family-Related Medicaid Application. Download the form here (https://www.myflfamilies.com/service-programs/access/common-access-florida-forms.shtml), print it out, complete it and mail it to:
    ACCESS Central Mail Center 
    P.O. Box 1770
    Ocala, Florida 34478-1770

Georgia

  1. Apply online through the Georgia Gateway portal: https://gateway.ga.gov/access/accessController?id=427a056ba982d864d159d2eec
  2. Apply in person at any Division of Family and Children Services office. Find a list of locations here: https://dfcs.georgia.gov/locations
  3. Apply by phone at 1 (877) 423-4746.
  4. 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

  1. Apply online through the Med-QUEST portal: https://medical.mybenefits.hawaii.gov/web/kolea/home-page
  2. Apply by phone at 1 (800) 603-1201 (toll-free), 1 (800) 316-8005 (toll-free TTY) or 711.
  3. Apply using the Application for Health Coverage & Help Paying Costs. 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_2_FINAL_fillable.pdf
    • 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: http://humanservices.hawaii.gov/locations/

Idaho

  1. Apply online using the Idalink portal: https://idalink.idaho.gov
  2. Apply by phone at 1 (877) 456-1233.
  3. Apply in person at any field office. Find a list of locations here: https://healthandwelfare.idaho.gov/Portals/0/FoodCashAssistance/CashAssistance/AABD/mapSRoffices_20110112sw.pdf
  4. 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

  1. Apply online through the Application for Benefits Eligibility (ABE) portal: https://abe.illinois.gov/abe/access/
  2. Apply with a paper application. Download the form here: https://www.dhs.state.il.us/onenetlibrary/12/documents/Forms/IL444-2378B-IES.pdf
  3. Apply in person at any FCRC.

Indiana

  1. Apply online through the FSSA Benefits Portal: https://fssabenefits.in.gov/bp/# 
  2. 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 
  3. Apply by phone at 1 (800) 403-0864.

Iowa

  1. Apply online through the DHS Services Portal: https://dhsservices.iowa.gov/apspssp/ssp.portal
  2. 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

  1. Apply online through the Medical Consumer Self-Service Portal: https://cssp.kees.ks.gov/apspssp/
  2. Apply using a paper application.

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

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

Louisiana

  1. Apply online through the Online Application portal: https://sspweb.lameds.ldh.la.gov/selfservice/
  2. 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.
  3. 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

  1. Apply online through My Maine Connection: https://www1.maine.gov/benefits/account/login.html
  2. 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
  3. Apply in person at a DHHS office. Find a list of locations here: https://www.maine.gov/dhhs/about/contact/offices

Maryland

  1. Apply online through Maryland Health Connection: https://www.marylandhealthconnection.gov
  2. Apply by phone at 1 (855) 642-8572 or 1 (855) 642-8573 (TTY).
  3. 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)
  4. Apply through the Enroll MHC mobile app. Download it here: https://www.marylandhealthconnection.gov/enrollmhc/

Massachusetts

  1. Apply online through Massachusetts Health Connector: https://www.mahealthconnector.org
  2. 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)
  3. Apply by phone at (800) 841-2900 or (800) 497-4648 (TTY) Monday through Friday, 8 a.m. to 5 p.m.
  4. 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

  1. Apply online through MI Bridges: https://newmibridges.michigan.gov/s/isd-landing-page?language=en_US
  2. Apply by phone at 1 (855) 789-5610.
  3. 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

  1. Apply online through MNSure: https://auth.mnsure.org/RIDP/?account_type=Individual
  2. 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

  1. Apply online through Access Mississippi: https://www.access.ms.gov 
  2. 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
  3. Apply in person at a Mississippi Medicaid Regional Office.

Missouri

  1. Apply online through MyDSS: https://mydssapp.mo.gov/CitizenPortal/application.do
  2. Apply using the Application for MO Healthnet. Download the form here: https://dss.mo.gov/fsd/formsmanual/pdf/im1ma.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

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

Nebraska

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

Nevada

  1. Apply online through ACCESS Nevada: https://accessnevada.dwss.nv.gov
  2. 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

New Hampshire 

  1. Apply online through the NH EASY portal: https://nheasy.nh.gov/#/
  2. Apply using the Application for Health Coverage & Help Paying Costs. Download the form here: https://www.dhhs.nh.gov/dfa/documents/dfa-800ma.pdf
  3. Apply by phone at 1-800-852-3345 ext. 9700.

New Jersey

  1. Apply online through NJ Family Care: http://www.njfamilycare.org
  2. Apply using the Application for Health Coverage & Help Paying Costs. Download the form here: http://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
  3. Apply in person at your local County Board of Social Services. Find a list of locations here: https://www.state.nj.us/humanservices/dfd/programs/njsnap/cbss/index.html

New Mexico 

  1. Apply online through the Yes NM portal: https://www.yes.state.nm.us/yesnm/home/index
  2. Apply using the Application for Assistance. Download the form here: https://www.hsd.state.nm.us/uploads/files/Looking%20for%20Assistance_Apply%20for%20Benefits/Apply%20for%20Benefits/NewMexicoStreamlinedApplicationFINAL092413%20(English).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)
  3. Apply by phone at (855) 637-6574.

New York 

  1. Apply online through the NY State of Health Marketplace: https://nystateofhealth.ny.gov/individual
  2. Apply by phone at (800) 541-2831.
  3. 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
  4. 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 

North Dakota

  1. Apply online with the North Dakota DHS: https://dhsbenefits.dhs.nd.gov
  2. 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.nd.gov/dhs/locations/countysocialserv/

Ohio

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

Oklahoma

  1. Apply online through the Health Care Authority: https://www.apply.okhca.org/Site/UserAccountLogin.aspx
  2. 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

  1. Apply online through the OregONE portal: https://one.oregon.gov
  2. 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)

Pennsylvania

  1. Apply online through the COMPASS portal: https://www.compass.state.pa.us/compass.web/Public/CMPHome
  2. Apply by phone at 1 (866) 550-4355
  3. Apply using the Pennsylvania Application for Benefits. Download the form here: https://www.dhs.pa.gov/Services/Assistance/Documents/Benefits%20Applications/PA-600-2-20-Final.pdf
  4. Apply in person at your local CAO.

Rhode Island

  1. Apply online through HealthSource RI: https://healthsourceri.com/how-to-enroll/
  2. Apply in person at your local Department of Human Services (DHS) office. Find a list of locations here: http://www.dhs.ri.gov/DHSOffices/index.php
  3. Apply by phone at 1 (855) 840-4774.

South Carolina

  1. Apply online through South Carolina Healthy Connections: https://apply.scdhhs.gov/CitizenPortal/application.do
  2. Apply using the Application for Medicaid and Affordable Health Coverage. Download the form here: https://www.scdhhs.gov/sites/default/files/FM%203400.pdf
  3. When the form is complete, return it in one of the following ways:
  4. Apply in person at your local county office.

South Dakota

  1. Apply online through DSS South Dakota: https://apps.sd.gov/ss36snap/web/Portal/Default.aspx
  2. 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

Tennessee

  1. Apply online through YourTexasBenefits: https://www.yourtexasbenefits.com/Learn/Home
  2. Apply using the paper application. Download the form or request a form by mail here: https://www.yourtexasbenefits.com/Learn/GetPaperForm
  3. Apply in person at a Community Partner Program. Find a location here: http://www.texascommunitypartnerprogram.com
  4. Apply by phone Monday through Friday, 8:00 AM to 6:00 PM, at 1-877-541-7905 or 2-1-1

Utah

  1. Apply online through myCase: https://jobs.utah.gov/mycase/
  2. 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
  3. Apply in person at a DWS office.

Vermont

  1. Apply online through Vermont Health Connect: http://vermonthealthconnect.gov
  2. Apply using the Application for Health Coverage & Help Paying Costs. Download the form here: https://info.healthconnect.vermont.gov/sites/hcexchange/files/205ALLMED%20non-LTC.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
  3. Apply by phone at 1 (855) 899-9600.
  4. Apply in person with an assister. Find one near you here: https://info.healthconnect.vermont.gov/sites/hcexchange/files/In%20Person%20Assister%20Directory.pdf

Virginia

  1. Apply through the Virginia CommonHelp portal: https://www.commonhelp.virginia.gov
  2. Apply using the Application for Health Coverage & Help Paying Costs. Download the form here: https://coverva.org/materials/magi_1.pdf
  3. 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

West Virginia

  1. Apply online through WVPath: https://www.wvpath.org
  2. 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
  3. Apply in person at your local DHHR office.
  4. Apply by phone at 1 (877) 716-1212.

Wisconsin

  1. Apply online through ACCESS Wisconsin: https://access.wisconsin.gov/access/
  2. 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)
  3. 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
  4. Apply in person at your income maintenance or tribal agency.

Wyoming

  1. Apply online through the Wyoming Eligibility System (WES): https://www.wesystem.wyo.gov/AVANCE_ONLINE_APP/Landing.action
  2. 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
  3. 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. 

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

woman frustrated open letter 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:

  1. 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.
  2. Your home address 
    • Use the same home address you used on your Medicaid application.
  3. Your phone number
  4. The detailed reason for requesting an appeal
  5. Any supporting documents that may help your case and prove your eligibility for Medicaid
  6. 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.

StateDeadline to AppealHow to AppealAppeals Contact Information
AlabamaWithin 60 days of the date listed on the denial noticeFile 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.
AlaskaWithin 30 days of the date listed on the denial noticeFile 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***
ArizonaN/AAppeal 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
ArkansasWithin 30 days of the date listed on the denial noticeSend 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
CaliforniaWithin 90 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*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 ***
ConnecticutWithin 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)
DelawareWithin 5 working days of receiving the noticeYou 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 ColumbiaWithin 90 days of the postmark on your noticeDownload, 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
FloridaWithin 90 days of receiving Notice of Action (NOA)Request a fair hearing in one of  three ways: 
Online by completing the form here: https://www.myflfamilies.com/about-us/office-inspector-general/appeal-hearings/fair-hearing-request-form.shtml
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
GeorgiaWithin 45 days of the date listed on the noticeAppeal 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 noticeRequest 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 
IdahoWithin 30 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
IllinoisWithin 60 days of receiving the noticeAppeal 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
IndianaWithin 60 days of the date listed on the noticeFollow 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
IowaWithin 90 days of the date on your Notice of DecisionSubmit 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  
KansasWithin 30 days of the written noticeMail a written request for a fair hearing to:
1020 South Kansas Avenue
Topeka, KS 66612 
Office of Administrative Hearings
Phone: (785) 296-2433
Kentucky *Contact the Division of Administrative Hearings: Health Services Administrative Hearings branch to inquire about requesting a fair hearingHealth Services Administrative Hearings
105 Sea Hero Road Suite 2
Frankfort, KY 40601
CHFS.HSAHB@ky.gov
Phone: (502) 564-6621
LouisianaDeadline listed on notice of denialComplete 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
MaineWithin 30 days of the date of denialSend 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
MarylandWithin 90 days of receiving the noticeDownload, 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
MassachusettsWithin 30 days of receiving the noticeDownload, 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
MichiganWithin 90 days of receiving the noticeDownload, 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
MinnesotaWithin 30 days of receiving the noticeComplete 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
MississippiWithin 30 days from the date of mailing on your noticeRequest 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*Contact the Division of Legal Services to inquire about requesting a fair hearingOffice 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 
MontanaWithin 90 days of the mailing date of the noticeSubmit 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
NebraskaWithin 60 days of receiving the noticeFile 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
NevadaWithin 90 days of the date of eligibility determination on the eligibility correspondence you receiveAppeal online here: https://www.nevadahealthlink.com/appeals/ 
OR
Download, print and complete the Appeals Request Form here: https://d1q4hslcl8rmbx.cloudfront.net/assets/uploads/2019/11/NVHL_Appeals_Request_Form_Final.pdf 
When complete, mail it to:Nevada Health LinkAttn.: 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 HampshireThe Department must receive your appeal request within 30 days of the date written on the noticeDownload, print and complete the Appeal Request Form here: https://www.dhhs.nh.gov/oos/aau/documents/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 JerseyWithin 20 days of the date on your Eligibility Determination NoticeThe appeals process varies based on the program for which you are denied. Learn about all appeals processes here: https://www.state.nj.us/humanservices/doas/documents/appeals_procedures.pdf Medicaid Fair Hearing Unit
Phone: (609) 588-2655
P.O. Box 712
Trenton, NJ 08625-0712
New MexicoWithin 90 days of the date on your Eligibility Determination NoticeRequest 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 YorkWithin 60 days of receiving the noticeRequest a fair hearing using the online request system here: https://errswebnet.otda.ny.gov/errswebnet/erequestform.aspx
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 CarolinaWithin 30 days of receiving the noticeComplete 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 DakotaWithin 30 days of the date on the notice of actionDownload, print and complete the Request for Hearing form here: http://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
OhioDepartment 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
OklahomaWithin 30 days of the date the OHCA sends written notice of actionDownload, print and complete the LD-1 Member Appeals Form here: https://www.okhca.org/individuals.aspx?id=21841
OR
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
OregonWithin 90 days of receiving the noticeDownload, 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
PennsylvaniaWithin 30 days of the mailing date on your letterDownload, print and complete the Fair Hearing Form here: http://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 IslandDeadline listed on notice Download, print and complete the Appeal Form here: http://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: http://www.dhs.ri.gov/DHSOffices/index.php 
Department of Human Services
Phone: 1 (855) 697-4347
South Carolina*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 DakotaWithin 30 days of the decision date from South Dakota MedicaidRequest 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*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
TexasWithin 90 days of receiving the noticeAppeal 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***
UtahWithin 30 days from the date the Medicaid Agency sent a denial notice Download, print and complete the Hearing Request form here:  https://medicaid.utah.gov/Documents/pdfs/Forms/HearingRequest2019.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*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
Virginia30 days or the time limit on your written noticeDownload, print and complete the Appeal Request Form here: https://www.dmas.virginia.gov/files/links/9/Client%20Appeal%20Request%20Form.pdf 
When complete, mail or fax it to:Department of Medical Assistance Services Appeals Division600 East Broad StreetRichmond, VA 23219Fax: (804) 452-5454
OR
Email a request for appeal to: appeals@dmas.virginia.go 
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*Contact the Board of Review to inquire about Medicaid eligibility appealsBoard of Review
State Capitol Complex
Building 6, Room 817-B
Charleston, WV 25305
Phone: (304) 558-0955
dhhroigbore@wv.gov 
WisconsinWithin 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 laterSend 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
WyomingWithin 30 days of being notifiedTo request an appeal, contact the contact the Customer Service Center Medicaid Customer Service Center
Phone: 1 (855) 294-2127

Medicaid Cost-Sharing

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

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)
ServiceCopay
Non-preventative physician visitBetween $1.30 – $3.90 per visit
PrescriptionsBetween $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
Service Copay
Office visit$3.40 – $10
Outpatient therapy$2 – $5
Prescriptions$2.30 – $4
Non-emergency surgery$30 – $50
Inpatient hospital stay$75
Non-emergency use of emergency room$8

Arkansas

Cost-sharing begins at 100% of the federal poverty line. 

ServiceCopay
Non-preventative physician visit$8 – $10 per visit
Inpatient hospital visit$140/day
Prescriptions$4 for generic drugs and preferred brand name drugs; $8 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 
ServiceCopay
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, immunizationsNo 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 are exempt from copayments.

ServiceCopay
Visit to a primary care provider$2 per visit
Specialist visit$2 per visit
Prescriptions$3 per prescription
Vision$2 per visit
Urgent care center (not an emergency room)$2 per visit
Radiation/chemotherapy$4 if performed in outpatient center, $2 if performed in doctor office
Inpatient hospital care$10 per covered day or 50% of the averaged allowable daily rate, whichever is less
Organ and transplant services$10 per covered day or 50% of the averaged allowable daily rate, whichever is less
Outpatient hospital services$4 per visit
Durable medical equipment (DME)$1 per day
Lab tests and x-rays$1 per date of service
Non-emergency visits to emergency room

Prescription drugs
$6 per visit

$1 for generic drugs and $3 for name brand drugs
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 centerNo 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 90 days after end of pregnancy

Additionally, there are no copayments for smoking cessation products.

Some Medicaid enrollees are required to make copayments for prescription medication. The table below lists copayment amounts for prescriptions.

Those who are required to make copayments have a monthly $15 out-of-pocket maximum. Once they pay $15 in a calendar month, they are exempt from remaining payments until the following month. 

ServiceCopay
Generic prescription$1 each
Brand-name prescription$3 each

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
ServiceCopay
Doctor visit$2 per visit
Hospital outpatient visits$3 per visit
Prescriptions2.5 percent of the Medicaid cost of the drug for a maximum of $7.50 per prescription
Non-emergency visit to the emergency roomMaximum $15 per visit

Georgia 

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

ServiceCopay
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 prescriptionsNo 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
ServiceCopay
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 prescriptionsNo 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
ServiceCopay
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 

ServiceTraditional Medicaid CopayHoosier Care Connect Copay
Non-emergency transportation$.50 – $2$1 each way
Emergency transportationNo copayNo copay
Prescriptions$3 per prescription (generic and brand-name)$3 per prescription (generic and brand-name)
Emergency room visit for non-emergenciesNo 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
ServiceCopay
Non-preventative doctor visit $4
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 drugsGeneric drugs $1, preferred brand name drugs $4, non-preferred brand name drugs 5% of cost ($8 minimum, $20 maximum)

Louisiana 

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

  • Children younger than 21 years of age
  • Long-Term Care recipients
ServiceCopay
Prescriptions$.50 – $3

Maine 

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

ServiceCopay
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.
ServiceCopay
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 sizePremium 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:

ServiceCopay (Income at or below 100 percent FPL)Copay (Income more than 100 percent FPL)
Doctor visits$2$4
Outpatient hospital visit$2$4
Non-emergency visit to an emergency department$3$8
Inpatient hospital visit$50 per admission$100 per admission
Prescriptions$1 per preferred drug, $3 per non-preferred drug$4 per preferred drug, $8 per non-preferred drug
Dental$3$4
Vision$2$2
Chiropractic services$1$3
Podiatry services$2$4
Hearing aids$3 per aid$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 conditionsNo 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
ServiceCopay
Prescriptions$1 per generic, $3 per brand-name; maximum $12 per month
Doctor visit (excluding preventive services)$3 per visit
Non-emergency visit to an emergency department $3.50
Preventive care, Radiology, Inpatient care, Mental health care, Eyeglasses, Durable medical equipment, Ambulatory surgery, Smoking cessation treatments or prescriptions, ImmunizationsNo copay

Mississippi 

In addition to federal exclusions, members residing in nursing homes or similar facilities  are exempt from copayments.

ServiceCopay
Prescriptions$3 per generic or brand-name
Doctor visit (excluding preventive services)$3 per visit
Dental $3 per visit
Outpatient hospital care$3 per visit
Inpatient hospital care$10 per day
Ambulance$3 per trip
Durable medical equipment, Orthotics and ProstheticsUp to $3
Eyeglasses$3 per pair
Home health care$3 per visit
Federally qualified health center or Rural health clinic services$3 per visit
Annual physical examNo copay

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. 

ServiceCopay
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
ServiceCopay
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
ServiceCopay
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
ServiceCopay
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 drugsNo copay

North Carolina 

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

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

ServiceCopay
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$4 per visit; $7.50 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
ServiceCopay
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 rentalNo copay

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

Cost to Medicaid ProgramCost 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
ServiceCopay
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
ServiceCopay
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
ServiceCopay
Doctor visits$3 per visit
Chiropractic services$1 per procedure
Prescriptions$1 per generic, $3.30 per brand-name 
Outpatient hospital care5 percent of allowable amount; maximum $50
Inpatient hospital care$50 per admission
Independent mental health practitioners$3 per procedure
Mental health clinics5% 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 care5 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 clinic5 percent of allowable amount
Independent mental health practitioner$3 per visit
Durable medical equipment, supplies and prosthetic devices5 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
ServiceCopaycolspancolspan
0-99% FPL100-199% FPL200% + FPL
Generic prescriptions$1.50 each
Brand-name prescriptions$3 each
Hospital ER (waived if admitted)$0 per visit$10 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.

ServiceCopay
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.

ServiceCopay
Prescriptions $1 – $3
Dental care$3 per visit
Outpatient hospital care$3 per day
Sexual assault-related servicesNo copayment

Virginia

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

ServiceCopay
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
ServiceCopaycolspancolspan
Up to 50% FPL with max of $8 out of pocket50.01 – 100% FPL with max of $71 out of pocket100.01% 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 ServicesNo 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 ServiceCopay
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
ServiceCopay
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: http://s3.amazonaws.com/onpointglobal.com/chipinfo-org-guides-chipinfo-guide-hr.pdf

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