How to apply for Medicaid?

Those who cannot access health insurance through a private entity have the option of applying for Medicaid .

Entering this government program is not complicated, but you must meet the eligibility requirements. This time we will focus on how to apply for Medicaid online.

As we have already described in Busconomico, Medicaid is a federal program focused on providing health insurance to people with fewer resources. This can mean low-cost or free treatment for different categories of beneficiaries:

• Children
• Disabled
• Pregnant women
• Low-income adults
• People over 65 years of age

How do I apply for Medicaid?

When it comes to enrollment for Medicaid, there are 2 ways to apply:

• You can complete the online form through the health insurance marketplace. In this case, you must enter the data requested on the page healthcare.gov to create an account. After this process, you will receive instructions on how to obtain the benefits associated with this federal coverage.
• You can contact the respective state medical agency. Some states have their own health care administration. Here you can check the health agency in each state to apply for Medicaid and learn more about the requirements and the application process.

If you need more information, you can also call the Health Insurance Marketplace phone number: 800-318-2596 

When should you contact your state medical agency?

We recommend that you contact the Medicaid program in your state when you have questions about any of these issues:

• Claims
• Eligibility
• Services and coverage
• Status of your application
• Provider enrollment
• Medicaid card loss/replacement
• How to find a Medicaid provider

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Benefits of applying for Medicaid

Although each state administration has its own policies and procedures regarding Medicaid, the law indicates that there are certain coverages that are mandatory and others that are optional. In this list, we have the following:

Mandatory benefits

• Medical services
• Family planning
• Laboratory and X-ray
• Rural health clinic
• Nursing services
• Health care transportation
• Home health aide services
• Inpatient hospital care services
• Federally qualified health centers
• Certified family nurse practitioners and pediatricians
• Outpatient hospital care services
• Tobacco cessation counseling for pregnant women
• Early and Periodic Screening, Diagnostic and Diagnostic Treatment (EPSDT)

Optional benefits

• Lenses
• Prosthesis
• Podiatry
• Optimetry
• Physiotherapy
• Chiropractic
• Dentures
• Dentistry
• Private Care
• Case Management
• Clinical Services
• Occupational therapy
• Hospice and nursing home
• Prescription drugs
• Respiratory care services
• Tuberculosis (TB)-associated care
• 1915(k) community first choice option
• Personalized nursing home care
• Psychiatric services for patients under the age of 21
• Self-directed attendant care services 1915(j)
• Care of mental illness for those 65 years of age or older
• Services related to speech disorders or impairments
• State plan for home and community-based services 1915(i)
• Other diagnostic, preventive, evaluative, and rehabilitative services
• Care homes for chronically ill enrollees (Sec. 1945)
• Intermediate facility care for individuals with an intellectual disability

Medicaid eligibility requirements

Medicaid eligibility criteria vary from state to state, and many local governments have expanded coverage to include more people with vulnerable conditions. If you are unsure whether you qualify, we suggest you apply to find out for sure.

Eligibility depends on factors such as age, disability, family size, annual household income, among others. An important aspect is the nationality or immigration status, because having citizenship or permanent residency makes it easier for you to access all the benefits offered by the Medicaid program.

Situation of Medicaid enrollment

After the decline in Medicaid enrollments from 2017 to 2019, data through September 2022 show that enrollment grew by 19.8 million people, up 27% since February 2020 and after the start of the pandemic.

This increase in enrollment reflects changes in the economy and in policy, such as the recent adoption of Medicaid expansion for the ACA. Add to this the continued inclusion provision under the FFCRA.

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Under that provision, states cannot drop enrollees while it is in effect. As compensation, local governments receive a temporary rate increase for Medicaid.

This has also stopped the momentary loss of coverage due to short term inclusions/exclusions. As part of the December 2022 decree, the continuous income provision will end in March 2023.

Also, there will be a gradual reduction in additional federal funding through December 2023. States that accepted this money can begin disenrolling people starting in April 2023, but they must meet certain requirements.

We hope this information will help you apply for Medicaid if you meet the minimum conditions required by the program. If you have any questions about this or any other topic, you can contact us through our social networks and other channels.

Español: ¿Cómo aplicar para Medicaid?