Medicaid and the Children's Health Insurance Program (CHIP) are the primary public health coverage safety net in the United States, and knowing how these programs work — and who they may serve — is the first step toward finding out whether your household could access coverage. If you're uninsured or underinsured, this article walks through current enrollment data, income thresholds by population group, required documents, and the application process from start to finish.

Data Snapshot

According to the Centers for Medicare & Medicaid Services (CMS) Medicaid and CHIP enrollment data, total combined enrollment reached approximately 90.4 million individuals as of recent reporting periods — roughly 1 in 4 Americans. That figure reflects the significant expansion of both programs since the Affordable Care Act's Medicaid expansion provisions took effect, though enrollment has shifted following the end of the COVID-19 continuous enrollment requirement in April 2023. During the subsequent "unwinding" period, states resumed eligibility redeterminations and millions of enrollees were disenrolled — some due to genuine changes in circumstances, others due to administrative issues such as outdated mailing addresses. Average monthly CHIP enrollment has held at approximately 7 to 8 million children, while Medicaid covers the remaining adult, senior, and disability populations across all 50 states and the District of Columbia. CMS publishes updated enrollment figures at cms.gov/data-research/statistics-trends-and-reports/medicaid-chip-enrollment-data.

These numbers matter for families because they reflect real program capacity and ongoing state-level activity. If you were disenrolled during the unwinding or have never applied, the programs remain open — and there is no waiting period to apply or reapply.

Who Medicaid and CHIP Are Designed to Serve

Medicaid is a joint federal-state program. The federal government sets minimum standards and provides matching funds; each state administers its own version under a different name and with its own rules within those federal guidelines. CHIP is a companion program specifically designed for children in families whose income exceeds the Medicaid threshold but who still cannot afford private insurance.

Both programs measure eligibility against the Federal Poverty Level (FPL), a figure updated annually by the U.S. Department of Health and Human Services (HHS). Because states set their own rules within federal minimums, the income limit that applies to your household depends on where you live and your family's composition.

Income Guidelines by Population Group

The figures below reflect approximate federal minimums and common state thresholds. Many states have expanded coverage beyond these levels.

Children (CHIP and Medicaid): Children are typically covered through Medicaid up to 133–138% of FPL and through CHIP from that threshold up to 200% of FPL or higher. Some states extend CHIP eligibility to 300% or even 400% of FPL, making CHIP available to families with moderate incomes who still face barriers to private coverage.

Pregnant individuals: Most states cover pregnant individuals up to at least 138% of FPL through Medicaid, and many states have extended that threshold to 200–300% of FPL. Postpartum coverage — extended to 12 months after delivery in many states under a recent federal option — is an important consideration for families planning ahead.

Parents and caretaker relatives: In states that have adopted the ACA Medicaid expansion, parents are generally covered up to 138% of FPL. In non-expansion states, income limits for parents can be significantly lower — sometimes below 50% of FPL — depending on the state.

Adults without dependent children: In the 40 states (plus D.C.) that have adopted Medicaid expansion as of 2024, non-disabled adults without children may be eligible up to 138% of FPL. In the remaining non-expansion states, this population generally has no Medicaid pathway unless they qualify through disability.

Seniors and people with disabilities: Eligibility rules for this population differ substantially and may involve asset tests in addition to income limits. Long-term care Medicaid, in particular, has separate financial eligibility criteria that vary widely by state.

What Documents You'll Likely Need

Gathering paperwork before you apply can reduce delays. While exact requirements vary by state, most Medicaid and CHIP applications ask for the following:

  • Proof of identity — driver's license, state-issued ID, passport, or birth certificate
  • Proof of state residency — utility bill, lease agreement, or official mail showing your current address
  • Proof of income — recent pay stubs (typically covering the last 30 days), employer letters, or tax returns if self-employed or a gig worker
  • Social Security numbers — for all household members applying for coverage
  • Immigration documentation — if applicable; lawful permanent residents and certain visa holders may be eligible for Medicaid, though eligibility rules vary
  • Proof of existing health insurance — if any household member already has coverage, this may affect how the state calculates eligibility
  • Bank statements — some states require these for seniors applying for long-term care Medicaid or for certain asset-tested populations

If you don't have all of these documents on hand, that should not stop you from starting an application. Most states allow applicants to submit what they have and provide missing documents within a defined window — typically 10 to 30 days after submission.

How to Apply for Medicaid or CHIP

All legitimate Medicaid and CHIP applications are free. No private company or third party should charge you a fee to apply.

Step 1: Locate Your State's Medicaid Agency

Each state administers Medicaid under its own name. California's program is called Medi-Cal; Texas operates STAR; New York uses Medicaid Managed Care. You can find your state's specific agency, contact information, and online application portal through Medicaid.gov or through Benefits.gov.

Step 2: Choose Your Application Method

Online: Most states offer an online portal where a standard application can be completed in 20 to 45 minutes. This is typically the fastest route and generates an immediate confirmation.

By phone: You can call your state Medicaid office directly. A caseworker can walk you through the application over the phone and note any documents you'll need to submit afterward.

By mail or in person: Paper applications are still accepted in most states. You can often pick one up at your local Department of Social Services, a federally qualified health center (FQHC), or a public library. Note: If you submit a paper form, you may be asked to provide consent for the agency to contact you by phone or text regarding your application status.

Through HealthCare.gov: If you apply for marketplace health coverage and your income may fall within Medicaid limits, the marketplace will automatically screen your application and transfer your information to your state Medicaid agency — no separate application required.

Step 3: Submit and Track Your Application

After submitting, you should receive a confirmation number or written notice. Federal rules require most states to process standard Medicaid applications within 45 days of receiving a complete application. Applications based on disability may take up to 90 days. CHIP applications for children are generally processed within 30 days.

If you haven't received a decision within those timeframes, contact your state Medicaid office directly to request a status update.

Step 4: Respond to Any Follow-Up Requests Promptly

Your state may send a request for additional documentation or schedule a brief phone interview to verify information. Responding quickly helps avoid delays or a denial based on an incomplete file. If you miss a deadline, contact the agency as soon as possible — many states will grant extensions.

What Medicaid and CHIP May Cover

If a household is found eligible, coverage under Medicaid and CHIP typically includes:

  • Preventive care and routine doctor visits
  • Emergency room and inpatient hospital services
  • Prescription medications
  • Mental health and substance use disorder treatment
  • Dental and vision care (particularly robust under CHIP for children)
  • Prenatal and maternity care
  • Long-term care and home- and community-based services for qualifying seniors and individuals with disabilities

Benefit amounts vary by household size and income, and the specific services covered depend on your state's Medicaid plan. Some states operate managed care systems where enrollees choose a health plan; others use fee-for-service arrangements.

What the COVID Unwinding Means for Families Today

During the COVID-19 public health emergency, federal law prohibited states from disenrolling Medicaid recipients. When that protection ended in April 2023, states began reviewing eligibility for all enrollees — a process CMS refers to as the "unwinding." Across the country, millions of people were disenrolled. Federal data indicates that a significant share of those disenrollments were procedural rather than based on actual ineligibility — meaning people lost coverage because of outdated contact information, unreturned mail, or paperwork that didn't reach them in time.

If you or a family member lost Medicaid coverage during or after the unwinding period, you may still be eligible and can reapply at any time. There is no waiting period after a disenrollment. Your state's income thresholds or your household's circumstances may also have changed since your last enrollment, so it's worth checking current eligibility even if you were previously denied.

If Your Application Is Denied

A denial is not the final word. You have the right to appeal any Medicaid or CHIP eligibility decision. Your denial notice will include instructions on how to request a fair hearing — a formal review of the decision. You can also contact a local legal aid organization or a certified application counselor, often available at no cost through community health centers, for help preparing your appeal. Acting quickly matters: most states set a deadline of 90 days from the date of the denial notice to request a hearing.

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Program eligibility and availability vary by state. Not affiliated with any government agency.

Last reviewed: July 2025