Medicaid is a vital public health insurance program for people with low income and limited resources. More than 83 million Americans are currently enrolled in the program, including 7.2 million older adults.^1,2

Jim, a 77-year-old Oklahoma resident, is one of them. When Jim’s wife of 56 years suddenly died, he faced two significant losses: the love of his life, and the income she earned that helped cover their out-of-pocket Medicare costs. When staff at his local Senior Center helped him apply and qualify for Medicaid, he was delighted.

“Medicaid is truly a lifeline for people like Jim,” said Jen Teague, Director of Health Coverage and Benefits at NCOA. “Not only does it remove a significant barrier to his insurance coverage right now—it also can help pay for any long-term nursing care he may need in the future.”

Jim had help navigating his Medicaid application. But many eligible older adults never submit an application because the process can feel overwhelming—or they don’t realize they qualify for assistance. For instance, did you know that millions of Americans age 65 and over like Jim receive both Medicare and Medicaid benefits?

“That’s why, if you think you or someone you know might qualify for Medicaid, you owe it to yourself to apply,” Teague said.

How to apply for Medicaid

First, it’s important to know that individual states manage their own Medicaid program. That means that your eligibility and coverage will depend on where you live (the federal government does require certain mandatory benefits for everyone). It also means that you will apply for benefits directly with your state Medicaid agency.

Still, the overall process is similar regardless of where you live. Get started by following the steps below.

Step 1: Check your eligibility

You may qualify for Medicaid based on your income, your age, your disability status, and other factors. While each state sets its own rules, you must at minumum³:

• Be a U.S. citizen or qualified non-citizen
• Live in the state where you are applying

In certain states with expanded Medicaid coverage, you could qualify for coverage based on your income alone if you are age 65 or under.

The best way to check your Medicaid eligibility is to contact your state's Medicaid office. You can also visit HealthCare.gov to see if you qualify for Medicaid based on your income.

Step 2: Gather your documentation

Having everything you need on hand before you fill out your Medicaid application can help you feel prepared. While your state may ask for additional information, start by collecting these basic documents⁴:

• Proof of citizenship or legal residence: This might include a U.S. passport, an alien registration card, or a naturalization certificate.
• Proof of age: This might include your birth certificate or driver’s license.
• Proof of income: This might include pay stubs (if you’re still working), your federal tax return, Social Security benefits verification letter, and pension statements, among others.
• A list of “countable assets”: This could include things like checking and savings accounts, investments, life insurance policies, certificates of deposit, and money market accounts (some states will ask for less).
• Proof of disability (if you live with one): This may include your official medical record or physician verification form.

Keep in mind that each state defines “countable assets” differently. In some, for instance, your primary residence, one automobile, and certain other personal property are exempt from consideration. You may wish to consult a knowledgeable professional who can offer unbiased advice about your specific situation. If you are age 65 or older, your State Health Insurance Assistance Program (SHIP) can be a good place to start.

Step 3: Fill out and submit your application

There are two ways to apply for Medicaid: through your state Medicare agency or the Health Insurance Marketplace.

Depending on which state you live in, you may be able to apply for Medicaid online. In some instances, you also may apply over the phone, in person, or by mail using a hard copy Medicaid application form.

There is no set enrollment period for Medicaid, which means you can submit your application at any time. Your local SHIP program can also help fill out your application.

Step 4: Look for your decision letter

You should receive a benefits decision within 90 days of submitting your Medicaid application.⁵ Most states (48) are able to determine benefits within 24 hours or less, though not all of them do.⁶

If you are eligible, you will get a notification letter in the mail telling you when your coverage will begin and how much you will pay for it out of your own pocket.⁵

If your Medicaid application is denied, you will receive a different letter explaining why. This letter will also include information about how to appeal the decision.⁵

At any time, you may check the status of your application by contacting your state Medicaid agency.

What if I disagree with the Medicaid benefits decision?

If you’re unhappy with the decision regarding your Medicaid benefits, you’re entitled to an appeals hearing.⁷ You can initiate the appeals process by contacting your state Medicaid agency and letting them know. You can also use your Medicaid denial notice. Write “I disagree with this decision and want to appeal it.” Sign and date the document and either mail it to your local Medicaid office or—more preferably—drop it off in person (be sure to keep a copy for your records). Within a few weeks, you should receive a letter from your state with details about your hearing.

Are there other programs that can help me?

Yes. Medicaid is one piece of the puzzle, but there are many other financial benefits programs available that help older adults pay for health care, prescription medications, food, housing costs, and more. NCOA’s BenefitsCheckUp® is a free online tool where you can browse for programs near you. Simply type in your ZIP code to get started—no need to create an account.

Sources

1. Medicaid.gov. August 2023 Medicaid & CHIP Enrollment Highlights. Found on the internet at https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html

2. Medicaid.gov. Seniors & Medicare and Medicaid Enrollees. Found on the internet at https://www.medicaid.gov/medicaid/eligibility/seniors-medicare-and-medicaid-enrollees/index.html

3. Medicaid.gov. Medicaid Eligibility. Found on the internet at https://www.medicaid.gov/medicaid/eligibility/index.html

4. Mark P. Cussen. “How to Qualify for Medicaid: Tips and Eligibility Requirements.” July 12, 2022. Found on the internet at https://www.investopedia.com/articles/financial-advisors/011816/4-tips-qualifying-medicaid.asp#toc-apply-for-coverage

5. LongTermCare.gov. Applying for Medicaid. Found on the internet at https://acl.gov/ltc/medicare-medicaid-and-more/medicaid/applying-for-medicaid

6. KFF. State Health Facts. Medicaid Eligibility Determinations. (As of January 1, 2023). Found on the internet at https://www.kff.org/health-reform/state-indicator/features-of-online-and-telephone-medicaid-applications/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

7. Elizabeth Dickey, J.D. “How to Appeal a Denial of Medicaid (Non-Eligibility).” Found on the internet at https://www.nolo.com/legal-encyclopedia/how-appeal-denial-medicaid-non-eligibility.html