At what age do you get medicaid

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Medicaid for Young Adults Age 18 and Older

Medicaid is a joint Federal and State program. It is partially funded by the Federal government and administered by States. It is for people with low incomes, with or without a disability. You can find out about your state’s program at Medicaid.gov.

There are several ways to qualify for Medicaid adult benefits at age 18. After age 18, an individual is seen as a “family of one” and parental income is no longer considered as part of their income. Many youth who do not qualify for Medicaid because their parent's income was too high become eligible at age 18 when only their own income is counted. (States that expanded Medicaid under Affordable Care Act [ACA] have coverage starting at age 19.  This may make it possible to transition from Medicaid for children or the Children’s Health Insurance Program (CHIP) to adult Medicaid, although this is not automatic, so it is necessary to apply.) Visit the HealthCare.Gov webpage to see how to apply for Medicaid.

Each state runs its own Medicaid program. Each state has its own eligibility rules and decides which services to cover. The names of the Medicaid program vary from state to state. Contact the Family-to-Family Health Information Center in your area to find out about your state’s Medicaid program.

Medicaid and Former Foster Youth

For young adults formerly in foster care, there are special provisions. Medicaid is available until age 26 for those who:

• exit foster care at age 18
• were on Medicaid while in foster care
• are not eligible for other Medicaid coverage (e.g., pregnant, parent, disabled)

No income is counted towards eligibility, and the young adult is eligible even if they have another offer of coverage through an employer. Children who were adopted or placed in guardianship at age 18 are not eligible for Medicaid under the former foster care coverage group.

Medicaid and SSI

In most states, Supplemental Security Income (SSI) recipients automatically qualify for Medicaid. Young adults who receive SSI benefits must be both significantly disabled and have low income and low assets. The SSI Program is administered by the Social Security Administration (SSA). However, even youth who received SSI benefits as children must reapply for adult SSI benefits at age 18.

Social Security Work Incentives

Don’t let concerns about SSI benefits stop you from encouraging your child to find an employment setting that is right for them. Parents of youth with disabilities are very aware of the importance of healthcare for their children. Many have heard that SSI recipients will lose their Medicaid coverage if they earn any money. As a result, some families discourage their young adults from joining the workforce. This is not true. Be aware that the Social Security Administration has “Work Incentive” programs that allow young adults with disabilities to continue to receive Medicaid coverage while they explore careers or attend postsecondary education or job training.

Make an informed choice. If your son or daughter receives SSI, contact a Work Incentives Planning and Assistance (WIPA) Project in your state to see how they can continue to receive health coverage through Medicaid while they work. WIPA projects are community-based organizations that receive grants from SSA to provide all Social Security and Supplemental Security Income (SSI) disability beneficiaries (including transition-age youth) with free work incentives planning and assistance.

WIPA services are available in every state, the District of Columbia, and the U.S. Territories of American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands. Call 1-866-968-7842 (Voice) or 1-866-833-2967 (TTY) for locations WIPA organizations or see the online SSA service provider directory.

Find more information about applying for SSI benefits.

Medicaid Buy-In Program

Private or employer-based health insurance generally does not cover services and supports such as personal assistance services that some people need to work and live independently. To encourage individuals who need this level of support to continue to work, most states, but not all, have a Medicaid Buy-In program. Medicaid Buy-In programs offer Medicaid coverage to people with disabilities who are working, and earning more than the allowable limits for regular Medicaid.

Home and Community Based Waivers

Home and Community Based Services (HCBS) Waivers are Medicaid programs that provide services in the home for persons who would otherwise require institutional care in a hospital or nursing facility. Without waiver services being delivered in the community, some young adults might not be able to live at home or receive needed supports in the workplace.

Find answers to common questions that families that are applying for free or low-cost health insurance for their children and teens through Medicaid or the Children's Health Insurance Program (CHIP) may have below.

Eligibility Information

Question: Is my child eligible for Medicaid or the Children's Health Insurance Program (CHIP)?

Answer: States have different income eligibility rules, but in most states, children up to age 19 with family income up to $50,000 per year (for a family of four) may qualify for Medicaid or the CHIP. In many states, family income can be even higher and children can still qualify. Young people up to 21 may be eligible for Medicaid. Youth who have "aged out" of foster care can be covered under Medicaid until they reach 26; there is no income limit for these youth.

Medicaid and CHIP coverage is for U.S. citizens and certain lawfully present immigrants. To find information about the Medicaid and CHIP programs in your state, go to Learn About Programs in Your State or call 1-877-KIDS-NOW (1-877-543-7669). When you call the free and confidential hotline, you’ll be connected to someone in your state who can help you learn whether your children may qualify and help you enroll them.

Question: Are teenagers eligible for coverage?

Answer: Yes, in every state, children from birth until their 19th birthday may be eligible for coverage.

Question: I have a job. Can my children and teens still qualify?

Answer: Yes, many children who are eligible for Medicaid and CHIP are in families where one or both parents are working. Working parents may not have health coverage through their jobs or the health plans they're offered may not cover their children. Many working families can't afford health insurance on their own.

Question: Who can apply for Medicaid or CHIP for a child?

Answer: A parent, grandparent, guardian or other authorized representative can apply on behalf of a child. If you're a teenager living on your own, your state may allow you to apply for Medicaid on your own behalf or any adult may apply for you.

Question: What if my children and teens are covered by Medicaid or CHIP already?

Answer: That's great! They already have comprehensive health insurance. If you're looking for a dentist for your child, use our dentist locator.

Question: Is there a limit on the amount of time my child or teen can remain enrolled in Medicaid or CHIP?

Answer: Children and teens can stay covered as long as they qualify. You'll need to renew their coverage once a year.

Question: How do I know when to renew Medicaid or CHIP coverage for my child or teen?

Answer: The program will contact you to let you know that it is time to renew your child's coverage.  Enrollment for Medicaid and CHIP is open year-round and must be renewed annually to maintain continuous coverage. Families who are already enrolled should make sure their contact information is up to date to ensure they do not miss important notices and can avoid gaps in coverage.

Question: Does receiving Medicaid or CHIP benefits affect someone’s immigration status?

Answer: The Department of Homeland Security will not consider applying for or receiving Medicaid or CHIP when making a “public charge” determination (except Medicaid for long-term institutionalization, such as nursing home care). Having Medicaid or CHIP won’t affect someone’s chances of becoming a Lawful Permanent Resident or U.S. citizen.

Covered Services

Question: What do Medicaid or CHIP cover?

Answer: All states provide comprehensive coverage for children, including:

• Routine check-ups
• Immunizations
• Doctor visits
• Prescriptions
• Dental and vision care
• Inpatient and outpatient hospital care
• Laboratory and X-ray services
• Emergency services
• Mental health services

Some specific benefits may be different from state to state.

Question: How do I find a health care provider (doctor, dentist or pharmacist) in my area who accepts Medicaid or CHIP?

Answer: There are several things you can do to find a health care provider:

• If you already have a health care provider for your child, ask if he or she accepts Medicaid, CHIP, or the health plan you selected. If you've been getting care from a provider that doesn't accept Medicaid, CHIP, or any of its health plans, you may be able to keep using that provider for a short time until you can find another provider, but you need to ask your state's Medicaid or CHIP program, or the health plan you selected.
• Most Medicaid and CHIP programs and health plans have websites that tell you which providers are available.
• Call your state Medicaid or CHIP agency or your health plan's member services department for help. The phone number is typically on eligibility letters or on the back of program enrollment cards. This information should also be available on your health plan's website or your state Medicaid or CHIP agency website.
• Be sure to let your provider know that you're enrolled in Medicaid or CHIP, or give the name of your health plan when you make an appointment for care. If you're having trouble getting an appointment to see a doctor, call your state Medicaid or CHIP agency or your health plan's member services department for help.
• Find a dentist in your area by using our online dentist finder search application.

Costs for Families

Question: What do families pay for coverage under Medicaid or CHIP?

Answer: Depending on their income, many families will get free health coverage for their children and teens. Other families may be required to pay a modest enrollment fee or premiums, and copayments for specific services. The rest of the coverage is paid for by the federal government and your state.

Application Process

Question: When can I apply for Medicaid or CHIP? Is there a certain time of year I should apply?

Answer: You can enroll in Medicaid or CHIP any time. There's no special open enrollment period for Medicaid or CHIP. You can apply at HealthCare.gov or directly with your state's Medicaid or CHIP agency.

Question: How do I apply for Medicaid or CHIP?

Answer: You can apply online, by phone, by mail or in person. You can apply using the HealthCare.gov online application  or directly at your state's Medicaid or CHIP agency. To get more information and help call 1-877-KIDS-NOW (1-877-543-7669), a free and confidential hotline, to be connected directly to your state's program.

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