How to get a child on medicaid
How to Qualify For Medicaid and CHIP Health Care Coverage
Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
Some states have expanded their Medicaid programs to cover all people below certain income levels.
See if you qualify for Medicaid based on income alone
Find out if you qualify for Medicaid based on your income. Enter your household size and state in our savings tool, and we'll tell you if you qualify for Medicaid or savings on a Marketplace plan.
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Even if you don't qualify for Medicaid based on income, you should apply. You may qualify for your state's program, especially if you have children, are pregnant, or have a disability. You can apply for Medicaid any time of year — Medicaid and CHIP do not have Open Enrollment Periods.
Note: Medicaid & CHIP program names vary. Learn what they’re called in your state.
Apply for Medicaid and CHIP 2 ways
1. Through the Health Insurance Marketplace®
Fill out an application through the Health Insurance Marketplace®.
- If it looks like anyone in your household qualifies for Medicaid or CHIP, we’ll send your information to your state agency. They’ll contact you about enrollment.
- When you submit your Marketplace application, you’ll also find out if you qualify for an individual insurance plan with savings based on your income instead. Plans may be more affordable than you think.
Create an account to start a Marketplace application.
2. Through your state Medicaid agency
You can also apply directly to your state Medicaid agency. Select your state below for your Medicaid agency’s contact information.
Medicaid in
Pick your state to start your application for health coverage.
Medicaid & CHIP basics
- Medicaid basics
- In all states, Medicaid provides coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
- In some states, Medicaid has been expanded to cover all adults below a certain income level. Learn more about Medicaid expansion in your state and what it means for you.
- Medicaid programs must follow federal guidelines, but coverage and costs may be different from state to state.
- Some Medicaid programs pay for your care directly. Others use private insurance companies to provide Medicaid coverage.
- Children’s Health Insurance Program (CHIP) basics
- In all states, CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women.
- Each state works closely with its state Medicaid program.
- In many cases, if you qualify for Medicaid your children will qualify for either Medicaid or CHIP.
- Learn more about CHIP.
More answers: Medicaid & CHIP
- What services does Medicaid cover?
Medicaid benefits are different in each state. But all states provide comprehensive coverage. See what services Medicaid offers in all states.
- What’s the income level to qualify for Medicaid?
It depends on the state you live in.
- If your state has expanded Medicaid: You can qualify based on income alone. See if you’ll qualify.
- If your state has not expanded Medicaid: You may qualify based on your state’s existing rules. These vary from state to state and may take into account income, household size, family status (like pregnancy or caring for young children), disability, age, and other factors. Because each state and each family situation is different, there’s no way to find out if you qualify without filling out an application.
- If my income’s too high for Medicaid, can I buy insurance through the Health Insurance Marketplace®?
Generally yes, as long as you qualify to use the Marketplace. Most people whose incomes are just above the level to qualify for Medicaid can pay very low premiums and out-of-pocket costs for private health insurance through the Marketplace. Find out if you’ll qualify for savings.
- What if I'm eligible for Medicaid, but want to buy an insurance plan in the Marketplace instead?
A Marketplace insurance plan would cost more than Medicaid and usually wouldn’t offer more coverage or benefits. If you qualify for Medicaid, you aren’t eligible for savings on Marketplace insurance. You’d have to pay full price for a plan.
- What if I have Medicaid now, but I have only limited benefits?
Some limited types of Medicaid coverage pay only for:
- Family planning
- Emergency Medicaid
- Tuberculosis services
- Outpatient hospital services
- Coronavirus disease 2019 (COVID-19) testing
If you have limited Medicaid coverage, you can fill out an application through the Health Insurance Marketplace® and find out if you qualify for comprehensive coverage through either Medicaid or a Marketplace insurance plan with savings based on your income.
- Important: If you have limited Medicaid coverage, when you fill out a Marketplace application and are asked if you have coverage now, don’t check the box saying you have Medicaid. Check “None of the above” instead.
- What rules apply to former foster children and Medicaid?
All states must offer former foster children uninterrupted Medicaid coverage until they turn 26, as long as at least one of the following is true:
- They were in the foster care system and received Medicaid benefits on their 18th birthday
- They aged out of the foster care system with Medicaid coverage after they were 18 or older
Note: If the foster child moves to a new state, the new state’s Medicaid agency may not provide coverage. Check with your state Medicaid agency to learn more.
- What if I’ve been turned down for Medicaid or CHIP coverage?
You may be able to buy a private health plan through the Marketplace instead. You may qualify for savings based on your income through a premium tax credit and savings on out-of-pocket costs. Many people can find plans for $75 or less per month.
- If your state Medicaid or CHIP agency said you’re not eligible
- If your state agency decides someone in your household isn’t eligible, you’ll get a notice explaining this.
- In most cases, the state will send your information to the Marketplace. The Marketplace will send you a notice explaining how to submit an application for a private insurance plan. The application will be pre-filled with information you gave the state agency.
- If your state hasn't expanded Medicaid coverage
- If your state hasn’t expanded Medicaid and your state agency said you’re not eligible under its current rules, you may have fewer options for coverage. Depending on your income you may not qualify for savings on a private insurance plan.
- Learn about your options if you’re in this situation.
Apply for Marketplace coverage if you lost of were denied Medicaid or CHIP
You may be able to get health coverage through the Marketplace with savings if you or others in your household:
- Had Medicaid or CHIP coverage, but recently lost your coverage.
- Currently have Medicaid or CHIP coverage, but will lose your coverage soon.
- Applied for Medicaid or CHIP coverage through your state agency and the state denied your application.
- Applied for coverage with the Marketplace and were found potentially eligible for Medicaid or CHIP coverage. Your state checked if you could get Medicaid or CHIP, but said you (or your household member(s)) don’t qualify.
Submitting a Marketplace application
Update your existing Marketplace application or create a new application right away to see if you (or other members of your household) are eligible to buy a Marketplace plan and get help with costs.
Log into your Marketplace account. If you don’t already have a Marketplace account, you can create one.
Start a new application, or update your existing one.
- To start a new application, choose your state and then select “Start my application.”
- If you have an existing application, select “Go to my applications & coverage,” and choose the one you want to update under “Your existing applications.”
Be sure your application includes:
- Your state’s recent decision about Medicaid and CHIP coverage.
- Information like your current income.
Answer the Medicaid/CHIP and household questions based on your situation. (Get tips to help you answer the Medicaid and CHIP application questions under Answering application questions.
Submit your completed application. You’ll get your eligibility results right away.
Enroll in a Marketplace plan, if eligible. Once you enroll, you’ll need to pay your plan’s premium to start your coverage.
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If you’re a member of a Federally-recognized tribe or an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder, you may be able to get additional cost savings when you enroll in a qualified Marketplace health plan. Get more health coverage information for American Indians & Alaska Natives.
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Getting your application results
You'll get results right away telling you if you or others in your household qualify for health coverage through the Marketplace. Based on how you answer your application questions, we may also check to see if you could still qualify for Medicaid or CHIP coverage. Review your results – they include:
- Information about savings on your Marketplace plan
- Other actions you may need to take to confirm your information
- Enrollment deadlines
Your eligibility results will also tell you if you or anyone in your household qualifies for a Special Enrollment Period, to enroll outside the Open Enrollment Period, or get an earlier coverage start date. If someone in your household recently lost, will soon lose, or were denied Medicaid or CHIP coverage, they may qualify for a Special Enrollment Period.
Learn more about Special Enrollment Periods.
Have questions?
Contact us or find help in your area.
Answering application questions
Here’s how to answer questions about Medicaid and CHIP on your Marketplace application:
- Someone in my household recently lost (or will soon lose) Medicaid or CHIP.
If you or someone in your household recently lost (or will soon lose) Medicaid or CHIP coverage:
- Someone in my household recently applied for Medicaid or CHIP and the state denied their application.
If you or others in your household recently applied for Medicaid or CHIP and were denied (Note: this means the household member(s) didn’t already have Medicaid or CHIP coverage when they applied):
- For each person in your household, answer the question that asks if the state found the person ineligible for Medicaid or CHIP in the past 90 days.
- Answer “yes” if both of the following conditions apply:
- Your state denied the person’s Medicaid or CHIP application in the past 90 days for any reason and;
- There haven’t been changes to your household income or size, or to the person’s citizenship or immigration status since your state denied the person’s Medicaid or CHIP application.
Then enter the date of the person’s Medicaid or CHIP denial letter. If you don’t know the exact date, enter your best guess.
- Answer “no” if any of the following conditions apply:
- Your state denied the person’s Medicaid or CHIP application more than 90 days ago.
- Your state denied the person’s Medicaid or CHIP application within the past 90 days, but there have been changes in your household income or size, or to the person’s citizenship or immigration status since the denial.
- The person applied for Medicaid or CHIP, but your state hasn’t responded yet.
- Your state denied the person’s Medicaid or CHIP application because of a disability determination, or because the person had too many assets.
- Your state denied the person’s Medicaid or CHIP application because the person didn’t submit all the required paperwork.
- Answer “no” if any of the following conditions apply:
If you answer “no,” we’ll check again to find out if that person may be eligible for Medicaid or CHIP.
- Someone in my household applied for state or Marketplace coverage during a certain period of time.
Select “yes” for any household member who applied for health coverage through their state or the Marketplace during the dates listed or if they applied with the Marketplace after a qualifying life event, like a birth, marriage or adoption.
- Someone in my household has special health care needs (like a disability or a condition that requires help with daily living activities).
If you already submitted a Marketplace application and told us someone in your household has special health care needs, it’s possible that your state may still be checking to see if that person qualifies for more health care services. When you review your Marketplace application, don't change your earlier answers, unless something changed since you last applied.
If you’re creating an application for the first time, be sure to tell us that someone in your household has special health care needs.
Rules for the provision of medical care to minors
1. Outpatient medical care includes all types of outpatient care permitted on an outpatient basis, for children, adolescents:
1.1. Preventive examinations of children and adolescents upon admission to preschool, secondary and higher educational institutions.
1.2. Preventive medical examinations of children and adolescents under 18 years of age attending educational institutions.
1.3. Carrying out by outpatient clinics according to the territorial production principle (with the exception of the purchase of immunobiological preparations) for children, adolescents, adults, vaccinations included in the national calendar of preventive vaccinations, in accordance with federal laws of September 17 1998 No. 157-FZ "On the immunoprophylaxis of infectious diseases", No. 52-FZ dated March 30, 1999 "On the sanitary and epidemiological well-being of the population", Order No. 229 of the Ministry of Health of the Russian Federation dated June 27, 2001 "On the national calendar of preventive vaccinations and calendar of preventive vaccinations according to epidemic indications”, Order of the Ministry of Health and Social Development of the Russian Federation of January 11, 2007 No. 14 “On Amendments to the Order of the Ministry of Health of Russia of June 27, 2001 No. 229“On the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications” and approval of the reporting form No. 68 “Information on the contingents of children and adults additionally immunized against hepatitis B, poliomyelitis, influenza, rubella, and on the movement of vaccines for immunization”.
1.4. Carrying out vaccinations in accordance with Order No. 141 of the Ministry of Health of the USSR of April 9, 1990 "On further improvement of measures for the prevention of tick-borne encephalitis", orders of the Ministry of Health of the Russian Federation of October 07, 1997 No. 297 “On improving measures to prevent rabies in humans” (with the exception of the purchase of immunobiological preparations), dated May 17, 1999 No. 174 “On measures to further improve the prevention of tetanus”.
1.5. Dispensary observation of patients, including certain categories of citizens who have the right to receive a set of social services; persons exposed to radiation; pregnant women, women in labor; healthy and sick children and adolescents; recovered from infectious diseases. nine0005 1.6. Dynamic medical monitoring of the growth and development of the child.
1.7. Fluorographic examination in the manner prescribed by the Decree of the Government of the Russian Federation dated December 25, 2001 No. 892 “On the implementation of the Federal Law “On Preventing the Spread of Tuberculosis in the Russian Federation”.
1.8. Provision of emergency medical care, diagnosis, treatment of 90,005 patients with acute diseases, injuries, poisoning, exacerbation of chronic diseases. nine0005 1.9. Consultations of specialists in the direction of the attending physician of the outpatient clinic.
1.10. Treatment in the day hospital of patients with acute and chronic diseases.
1.11. Treatment in hospitals at home for patients with acute and chronic diseases, whose condition does not require round-the-clock monitoring in hospitals.
1.12. Rehabilitation treatment as directed by a doctor.
1.13. Preparation of documents for referral for examination of patients to the Bureau of Medical and Social Expertise to determine permanent disability and an individual rehabilitation program; paperwork for the provision of high-tech medical care. nine0005 1.14. Conducting clinical observation and diagnostic examinations of contact patients in the foci of infectious diseases.
1.15. Medical advice on determining the professional suitability of minors in the manner and on the terms determined by this Program in accordance with the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens dated July 22, 1993 No. 5487-1.
1.16. Registration of documents for referral to sanatorium-resort treatment of citizens. nine0005 1.17. Medical examination of citizens (according to the list of diseases and types of medical care within the framework of the basic program of compulsory medical insurance) as directed by the medical commissions of military commissariats based on the results of a medical examination in accordance with Article 5.1 of the Federal Law of March 28, 1998 No. 53-FZ "On military duty and military service” and Decree of the Government of the Russian Federation dated February 25, 2003 No. 123 “On Approval of the Regulations on Military Medical Expertise”. nine0005 1.18. Conducting a comprehensive laboratory study of adolescents 15-18 years old with a referral from a pediatrician of an educational institution to create a reproductive health passport.
PROVIDING MEDICAL ASSISTANCE TO MINORS - GBUZ YANAO
Very often in a children's clinic you can see children and teenagers who came to see doctors without being accompanied by their father or mother. The current generation believes that it is very independent and does not need the guardianship of the elders. But for sure, not many parents know that by sending a minor teenager alone to see a doctor, or with one of the adults, sometimes not even relatives, they thereby violate the current legislation of the Russian Federation. nine0003
In such situations, doctors have every right to refuse to see your child, because he is not accompanied by parents, and if accompanied by adults who are not legal representatives of the child, they do not have written consent to this.
Surely many will object: my children always went by themselves, or they were accompanied by their grandmother, and everything was fine. Indeed, until recently, it was possible to bring a child to any family member, or even a nanny, to an appointment at a polyclinic. But since November 2011, the rules have changed. Now, according to the Federal Law of November 21, 2011 No. 323-FZ “On the Basics of Protecting the Health of Citizens in the Russian Federation”, any relatives of a child should only go to the doctor with special consent, from parents or legal representatives, drawn up in writing, and certify with a notary document is not required. nine0003
Consent to a whole list of procedures and manipulations (consent to medical intervention) is also required. It should be signed only by official representatives of children (parents, guardians, adoptive parents or trustees) in the presence of an employee of a medical institution. If such a document is not available, then the doctor has every right to refuse to conduct an ultrasound, electrocardiogram or vaccination. As a rule, parents make such consent at the appointment with the local pediatrician, while in the consent the legal representative of the child can indicate the last name, first name, patronymic and contact phone number of those people (grandmother, brother, nanny, etc.) whom he trusts communicate information about the health of the child. Consent to the provision of information constituting a medical secret can also be issued in the form of a separate document (in case the circle of people whom parents trust has expanded or changed). nine0003
With regard to independent visits to the doctor by a teenager, the doctor is obliged to accept a child without the presence of a father or mother and without a power of attorney (consent) from them only if the child is already 15 years old. Minors over 15 years of age have the right to independently issue consent to medical intervention.
If a minor under the age of 15 is present at the doctor's office, unaccompanied by an adult, and it becomes necessary to prescribe treatment or perform any manipulations, then the doctor will not be able to do this without the presence of a legal representative. nine0005 All of the above does not apply to emergency care.
Relatives of minors who are not parents, guardians or trustees (grandparents, brothers, sisters, nannies, etc.) have the right to get acquainted with the medical records of the minor, as well as receive information about the state of his health only with the consent of the legal representative, executed in the proper way (clause 4, part 4, article 13, clause 4, article 22 of Federal Law No. 323-FZ).
Relatives of minors who are not parents, guardians or trustees (grandparents, brothers, sisters, etc.) have the right to get acquainted with the medical records of a minor, as well as receive information constituting a medical secret (about the state of health and diagnosis of a minor, about the results examination, the presence of the disease and the prognosis, methods of treatment, the risk associated with them, possible options for medical intervention, their consequences, the results of the treatment, etc. ) only with the consent of the legal representative, duly executed (paragraph 4 of part 4 of Art. 13, clause 4, article 22 of the Federal Law No. 323-FZ “On the Basics of Protecting the Health of Citizens in the Russian Federation). nine0005 Informed voluntary consent to medical intervention or refusal of it is given by one of the parents or other legal representative of a minor (part 2 of article 20 of Federal Law No. 323-FZ).
Minors over the age of fifteen or drug addicted minors over the age of sixteen have the right to informed voluntary consent to medical intervention or to refuse it in accordance with Federal Law No. 323-FZ.
Medical interventions for minors without the consent of parents (legal representatives) are allowed only for emergency indications, to eliminate the threat to a person’s life and if his condition does not allow him to express his will (Article 20 of Federal Law No. 323-ФЗ “On the Basics of Protecting the Health of Citizens in the Russian Federation” ).
The legal representatives of minors under 14 years of age (juveniles) are parents, adoptive parents, guardians (Article 28 of the Civil Code of the Russian Federation, Article 64 of the Investigative Committee of the Russian Federation).
The legal representatives of minors aged 14 to 18 are parents, adoptive parents, trustees (Article 26 of the Civil Code of the Russian Federation, Article 64 of the Investigative Committee of the Russian Federation). nine0005 In a children's clinic, it is not allowed to provide medical care (survey, examination, medical manipulations, research, medical procedures, etc.) to minor children without the presence of parents or legal representatives, because:
o Caring for children is the responsibility of parents (Article 38 Constitution of the Russian Federation)
o The child has the right to protect his rights and legitimate interests, which are carried out by parents or legal representatives (Article 56 of the Family Code of the Russian Federation).