In these tough times, when so many people have lost their jobs and and their health insurance, Medicaid and the Children’s Health Insurance Program (CHIP) are lifelines families can turn to for help covering the cost of health care.
Medicaid and CHIP provide free or low-cost health coverage for children and pregnant women with low and moderate incomes. Medicaid coverage is available to low-income adults without dependent children in states that expanded Medicaid under the Affordable Care Act and is available to some low-income parents in states that have not yet expanded Medicaid.
To help families in need of affordable health coverage, we answer some of the questions likely on their minds at this critical time.
Do we qualify for Medicaid or CHIP?
The Medicaid income guidelines vary by state so look up your state on our Kids Health Report and scroll to the “Who Qualifies” section to see specific income guidelines for children, pregnant women and parents. We are in the process of adding state income guidelines for adults without dependent children but, in the meantime, you can check this spreadsheet for that information.
How do I enroll?
Medicaid and CHIP are open for enrollment all year long. States look at current monthly income, so recently unemployed people should be able to enroll. To find out how to enroll in your state, call 1-877-KIDS-NOW (543-7669) or visit InsureKidsNow.gov for a link to your state’s online application.
What information will I need to have ready to apply?
You will need to provide information such as name, date of birth, and gender for all members of the household. You will need to provide information about all sources of income received by household members and whether individuals have other insurance. For more on what counts as income, read this blog by Tricia Brooks. You will also need to provide Social Security numbers for anyone applying for coverage.
Can I qualify even if I own a house, car or other assets?
For most people, income is the primary basis of eligibility. Owning a house or other assets does not count unless you are eligible as a low-income senior (over 65 years of age) or are disabled.
How long will it take to enroll?
Many state Medicaid agencies are being inundated with requests for help right now so call center response times may be longer than usual. Enrolling online is the best and potentially fastest way to enroll, however, help should be available over the phone. States have 45 days to process applications but the good news is that once you are enrolled, Medicaid coverage is effective back to the date of your application. If you have outstanding medical expenses, Medicaid may also cover your medical expenses incurred up to 90 days prior to your application date, but you will have to request “retroactive” Medicaid.
What if I earn too much to qualify for Medicaid or CHIP but can’t afford private health insurance?
Many individuals are eligible for financial assistance in purchasing a private health plan through the Affordable Care Act health insurance Marketplaces. Typically, consumers can only enroll in Marketplace coverage during the annual open enrollment period, unless they experience a life change such as losing health insurance, getting married, or moving. Many of the millions of people who have recently lost their jobs also lost their job-based insurance; these individuals will have a 60-day window in which to sign up for Marketplace coverage. However, many who lost their jobs may not have coverage through their employer (less than 30 percent of small businesses offer health insurance to their employees). Absent another life change, these individuals would not automatically qualify for a special enrollment opportunity. Twelve of the 13 states that operate their own Marketplaces are allowing the uninsured to sign up for Marketplace plans through a special enrollment period. (Those states are California, Colorado, Connecticut, DC, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont and Washington.)
Visit the Georgetown University Center on Health Insurance Reforms Navigator Guide for answers to your questions about Marketplace plans.
Can we sign up for Medicaid, CHIP or marketplace health coverage if we are not U.S. citizens?
In most states, legal permanent residents are eligible for Medicaid if they have been in the U.S. for at least five years. However, many states choose to cover lawfully residing children and pregnant women without the five-year wait (as shown on the map). Additionally, Medicaid covers emergency services for immigrants who are otherwise eligible (i.e., income-eligible).